Fluid controller

ABSTRACT

A fluid conditioning system is adapted to condition the fluid used in medical and dental cutting, irrigating, evacuating, cleaning, and drilling operations. The fluid may be conditioned by adding flavors, antiseptics and/or tooth whitening agents such as peroxide, medications, and pigments. In addition to the direct benefits obtained from introduction of these agents, the laser cutting properties may be varied from the selective introduction of the various agents.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No.12/631,642 (Att. Docket BI9914CIP), filed Dec. 4, 2009 and entitledFLUID CONDITIONING SYSTEM, which is related to U.S. application Ser. No.11/330,388 (Att. Docket BI9914P), filed Jan. 10, 2006 and entitled FLUIDCONDITIONING SYSTEM and to U.S. application Ser. No. 11/033,044 (Att.Docket BI9694P), filed Jan. 10, 2005 and entitled FLUID CONDITIONINGSYSTEM, the entire contents of which are expressly incorporated hereinby reference.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates generally to medical cutting, irrigating,evacuating, cleaning, and drilling techniques and, more particularly toa device for cutting both hard and soft materials and a system forintroducing conditioned fluids into the cutting, irrigating, evacuating,cleaning, and drilling techniques.

2. Description of Related Art

A prior art dental/medical work station 11 is shown in FIG. 1. A vacuumline 12 and an air supply line 13 supply negative and positivepressures, respectively. A water supply line 14 and an electrical outlet15 supply water and power, respectively. The vacuum line 12, the airsupply line 13, the water supply line 14, and the electrical outlet 15are all connected to the dental/medical (e.g., dental or medical) unit16.

The dental/medical unit 16 may comprise a dental seat or an operatingtable, a sink, an overhead light, and other conventional equipment usedin dental and medical procedures. The dental/medical unit 16 mayprovide, for example, water, air, vacuum and/or power to instruments 17.These instruments may include, for example, an electrocauterizer, anelectromagnetic energy source, a sonic or ultrasonic source, amechanical or electrical drill, a mechanical saw, a canal tinder, asyringe, an irrigator and/or an evacuator. Various other types,combinations, and configurations of dental/medical units 16 andsubcomponents implementing, for example, an electromagnetic energydevice operating with a spray, have also existed in the prior art, manyor most of which may have equal applicability to the present invention.

The electromagnetic energy source is typically a laser device coupledwith a delivery system. The laser device 18 a and delivery system 19 a,both shown in phantom, as well as any of the above-mentionedinstruments, may be connected directly to the dental/medical unit 16.Alternatively, the laser device 18 b and delivery system 19 b, bothshown in phantom, may be connected directly to the water supply line 14,the air supply line 13, and the electric outlet 15. The mentioned andother instruments 17 may be connected directly to any of the vacuum line12, the air supply line 13, the water supply line 14, and/or theelectrical outlet 15.

The laser device 18 and delivery system 19 may typically comprise anelectromagnetic cutter for dental or medical use, although a variety ofother types of electromagnetic energy devices operating with fluids(e.g., jets, sprays, mists, or nebulizers) may also be used. An exampleof one of many varying types of conventional prior art electromagneticcutters is shown in FIG. 2. According to this example of a prior artapparatus, a fiber guide tube 30, a water line 31, an air line 32, andan air knife line 33 (which supplies pressurized air) my be fed from thedental/medical unit 16 into a hand-held apparatus 34. A cap 35 fits ontothe hand-held apparatus 34 and is secured via threads 36. The fiberguide tube 30 abuts within a cylindrical metal piece 37. Anothercylindrical metal piece 38 is a part of the cap 35. When the cap 35 isthreaded onto the hand-held device 34, the two cylindrical metal tubes37 and 38 are moved into very close proximity of one another. Thepressurized air from the air knife line 33 surrounds and cools a laserbeam produced by the laser device as the laser bridges a gap orinterface between the two metal cylindrical objects 37 and 38. Air fromthe air knife line 33 flows out of the two exhausts 39 and 41 aftercooling the interface between the two metal cylindrical objects 37 and38.

Energy from the laser device exits from a fiber guide tube 42 and isapplied to a target surface of a treatment/surgical site, which can bewithin a patient's mouth, for example, according to a predeterminedsurgical plan. Water from the water line 31 and pressurized air from theair line 32 are forced into the mixing chamber 43 wherein an air andwater mixture is formed. The air and water mixture is very turbulent inthe mixing chamber 43, and exits the mixing chamber 43 through a meshscreen with small holes 44. The air and water mixture travels along theoutside of the fiber guide tube 42, and then leaves the tube 42 andcontacts the area of surgery. The air and water spray coming from thetip of the fiber guide tube 42 helps to cool the target surface beingcut and to remove materials cut by the laser.

Water is generally used in a variety of laser cutting operations inorder to cool the target surface. Additionally, water is used inmechanical drilling operations for cooling the target surface and forremoving cut or drilled materials therefrom. Many prior art cutting ordrilling systems use a combination of air and water, commonly combinedto form a light mist, for cooling a target surface and/or removing cutmaterials from the target surface.

The use of water in these and other prior art systems has been somewhatsuccessful for purposes of, for example, cooling a target surface orremoving debris therefrom. These prior art uses of water in cutting anddrilling operations, however, may not have allowed for versatility,outside of, for example, the two functions of cooling and removingdebris. In particular, medication treatments, preventative measureapplications, and aesthetically pleasing substances, such as flavors oraromas, may have not been possible or used during cutting or drillingoperations, including those using systems with water, for example, forcooling or removing debris from a target surface. A conventionaldrilling operation may benefit from the use of an anesthetic near thedrilling operation, for example, but during this conventional drillingoperation only water and/or air are often used. In the case of a lasercutting operation, a disinfectant, such as iodine, could be applied tothe target surface during drilling to guard against infection, but thisadditional disinfectant may not be commonly applied during such lasercutting operations. In the case of an oral drilling, cutting, or therapyoperation, unpleasant tastes or odors, which may be unpleasing to thepatient, may be generated. The common use of only water during this oralprocedure does not mask the undesirable taste or odor. A need has thusexisted in the prior art for versatility of applications and oftreatments during drilling and cutting procedures.

Compressed gases, pressurized air, and electrical motors are commonlyused to provide a driving force for mechanical cutting instruments, suchas drills, in dentistry and medicine. The compressed gases andpressurized water are subsequently ejected into the atmosphere in closeproximity to or inside of the patient's mouth and/or nose or any othertreatment/surgical site. The same holds true for electrically driventurbines when a cooling spray (air and water) is typically ejected intothe patient's mouth, as well. These ejected fluids commonly containvaporous elements of tissue fragments, burnt flesh, and ablated ordrilled tissue. The odor of these vaporous elements can be quiteuncomfortable for the patient, and can increase trauma experienced bythe patient during treatment, drilling, or cutting procedures. In suchdrilling or cutting procedures, a mechanism for masking smells and odorsgenerated from the cutting or drilling may be advantageous.

Another problem exists in the prior art with bacteria growth on surfaceswithin dental or surgical operating rooms. Interior surfaces of air,vacuum, and water lines of a dental/medical unit, for example, aresubject to bacteria growth. In water lines, the bacterial growth is partof the biofilm that may form on an inside of tubing forming a waterline. Additionally, the air and water used to cool the tissue being cutor drilled within a patient's mouth are often vaporized into air above atissue target to some degree or are projected onto a target surface.This vaporized air and water together with projected fluid may condenseonto a surface of exposed tissue as well as onto the dental/medicalequipment proximal to the treatment site. These surfaces typically aremoist, a condition that can promote bacteria growth, which isundesirable. A system for reducing the bacteria growth within air,vacuum, and water lines, and for reducing the bacteria growth resultingfrom condensation on exterior surfaces (e.g., instruments, devices, ortissue), is needed to reduce sources of contamination of the treatmentsite as well as contamination of equipment adjacent to the treatmentarea within a dental/surgical operating room.

SUMMARY OF THE INVENTION

An embodiment of the present invention comprises a fluid conditioningsystem adaptable to existing medical and dental apparatuses, includingthose used for cutting, irrigating, evacuating, cleaning, drilling, andtherapeutic procedures. The fluid conditioning system may employflavored fluid in place of or in addition to regular tap water or othertypes of water (e.g., distilled water, deionized water, sterile water,or water with a controlled number of colony forming units (CFU) permilliliter, and the like), during various clinical operations. In anexemplary case of a laser surgical operation, electromagnetic energy isfocused in a direction of tissue to be cut or treated, and a fluidrouter routes flavored fluid in the same direction. The flavored fluid,which may appeal to the taste buds of a patient undergoing the surgicaloperation, may include any of a variety of flavors, such as a fruitflavor or a mint flavor. In procedures employing a mist or air spray,scented air may be used to mask a smell of burnt or drilled tissue. Thescent may function as an air freshener, even for operations outside ofdental applications.

Conditioned fluids may be used for hydrating and cooling a surgical siteand/or for removing tissue. The conditioned fluids may include anionized solution, such as a biocompatible saline solution, and mayfurther include fluids having predetermined densities, specificgravities, pH levels, viscosities, or temperatures, relative toconventional tap water or other types of water. Additionally, theconditioned fluids may include a medication, such as an antibiotic, asteroid, an anesthetic, an anti-inflammatory, an antiseptic ordisinfectant (e.g., antibacterial or antiseptic), adrenaline,epinephrine, or an astringent. A typical conditioned fluid may alsoinclude vitamins (e.g., vitamin C (ascorbic acid) vitamin E, vitamin B-₁(thiamin), B-₂ (riboflavin), B-₃ (niacin), B-₅ (pantothenic acid), B-₆(pyridoxal, pyridoxamine, pyridoxine), B-₁₂ (cobalamine), biotin or Bcomplex, bioflavonoids, folic acid, vitamin A, vitamin D, vitamin K),aloe vera, natural anti-inflammatory, antioxidant or anti-histamineremedy and other such ingredients and solutions, herbs, remedies orminerals. Still further, the conditioned fluid may include atooth-whitening agent that is adapted to whiten teeth of patients. Thetooth-whitening agent may comprise, for example, a peroxide, such ashydrogen peroxide, urea peroxide, or carbamide peroxide, or any otherwhitening agent. The tooth-whitening agent may have a viscosity on anorder of about 1 to 15 centipoises (cps). In other embodiments, fluidconditioning agents additionally may comprise anticaries, antiplaque,antigingivitis, and/or antitartar agents in fluid or solid (i.e.,tablet) form.

Introduction of any of the above-mentioned conditioning agents toconventional fluid such as tap water (or other types of water such asdistilled water, deionized water, sterile water, or water with acontrolled number of CFU/ml, and the like) used in a cutting, drilling,or therapeutic operation may be controlled by a user input. Thus, forexample, a user may adjust a knob or apply pressure to a foot pedal inorder to introduce iodine into water before, during (continuously orintermittently), or after a cutting operation (including ablation orvaporization) has been performed. An amount of conditioning may beapplied to air, fluid water), and/or jet, spray, mist, nebulizer mist orany other type of such sprays as a function of a position of the footpedal, for example. A pre-measured or pre-mixed dose of conditioningagents may be introduced via a cartridge according to an embodiment ofthe present invention. In another embodiment, a cartridge is providedthat will mix an appropriate dose of conditioning agent(s) prior to orduring a procedure. The cartridge can be implemented, alone or as partof a fluid delivery system, at any location in a path of a fluid sourceor lines or along an air line or at an air source. The cartridge canalso be part of a separate fluid delivery system that provides, forexample, sterile and non-sterile fluids to a handpiece (dental, medicalregular or medical endoscopic).

According to one broad aspect of the present invention, an apparatususing conditioned fluid to treat a target (e.g., a tissue target),comprises a fluid output pointed in a general direction of aninteraction region (e.g., interaction zone), the fluid output beingconstructed to place conditioned fluid (e.g., conditioned fluidparticles) into the interaction region, the interaction region beingdefined at a location (e.g., volume) adjacent to (e.g., on, or ifinteraction zone above) the target and the conditioned fluid beingcompatible with the target, and further comprises an electromagneticenergy source pointed in a direction of the interaction region, theelectromagnetic energy source being constructed to deliver into theinteraction region a concentration (e.g., a peak concentration) ofelectromagnetic energy (e.g., that is greater than a concentration ofelectromagnetic energy delivered onto the target), the electromagneticenergy having a wavelength which is substantially absorbed by theconditioned fluid in the interaction region, wherein the absorption ofthe electromagnetic energy by the conditioned fluid energizes the fluidcauses the fluid to expand) and wherein disruptive forces are impartedonto the target.

The fluid output can be configured to generate a spray (e.g., jet, mist,or nebulizer mist) of atomized particles for placement into a volume ofair above the tissue to be cut, and electromagnetic energy from theelectromagnetic energy source, for example, a laser beam generated by alaser device, can be focused into the volume of air. The electromagneticenergy has a wavelength, λ, which may be chosen so that theelectromagnetic energy is substantially (e.g., highly) absorbed by theatomized particles in the volume of air. In certain implementations,absorption of the electromagnetic energy by the atomized fluid particlescauses the atomized fluid particles to expand, explode and/or tootherwise impart disruptive/removing (e.g., mechanical) forces (e.g.,cutting) onto the tissue. In certain implementations, absorption of theelectromagnetic energy by the atomized particles causes the atomizedparticles to expand or explode and disruptive/removing cutting forcesare imparted onto the tissue. The expanding or exploding can cause aneffect, whereby, at least to some extent, the electromagnetic energydoes not directly cut the tissue but, rather, or additionally, expandingor exploding fluid and fluid particles are used, at least in part, todisrupt and/or cut the tissue. In other embodiments, exploding atomizedfluid particles may not affect at all, or may affect a percentage butnot all of, the cutting of tissue. Examples of such embodiments aredisclosed in U.S. application Ser. No. 11/033,032, filed Jan. 10, 2005and entitled ELECTROMAGNETIC ENERGY DISTRIBUTIONS FORELECTROMAGNETICALLY INDUCED DISRUPTIVE CUTTING, the entire contents ofwhich are incorporated herein by reference to the extent compatible andnot mutually exclusive. The atomized fluid particles may be formed fromfluid conditioned with flavors, scents, ionization, medications,disinfectants (e.g., antibacterial agents and antiseptics), and otheragents such as anticaries, antiplaque, antigingivitis, and antitartaragents in fluid or solid (tablet) form, as previously mentioned.

Since the electromagnetic energy is focused directly on the atomized,conditioned fluid particles, the disruptive/cutting forces may beaffected by the conditioning of the atomized fluid particles. Anefficiency of disruptive and/or cutting can be related (e.g.,proportional) to an absorption of the electromagnetic energy by thefluid (e.g., atomized fluid particles). Characteristics of theabsorption can be modified by changing a composition of the fluid. Forexample, introduction of a salt into the fluid (e.g., water) beforeatomization, thereby creating an ionized solution, may cause changes inabsorption—resulting in cutting properties different from thoseassociated with regular water. These different cutting properties, whichmay be associated with changes in cutting power, may be desirable. Apower level of the laser beam may be adjusted to compensate for theionized fluid particles. Additionally, cutting power may be controlledby pigmenting the atomized fluid particles or by forming (e.g., mixing)the atomized fluid particles at least in part of (e.g., with) carbonatedfluid to either enhance or retard absorption of the electromagneticenergy. For example, two sources of fluid may be used, with one of thesources producing fluid containing a pigment or any other particles(e.g., gas from the carbon or other solid particles) and the otherproducing a fluid not having a pigment or any other particles (e.g., gasfrom carbon or other solid particles).

Another feature of the present invention places a disinfectant into air,spray, mist, nebulizer mist, jet, or water used for dental or surgicalapplications. This disinfectant can be periodically routed through air,mist, or fluid (e.g., water) lines to disinfect interior surfaces ofthese lines. This routing of disinfectant (e.g., antibacterial orantiseptic agents) can be performed, for example, in the context oflaser or other treatment or cutting procedures, before or during(continuously or intermittently) procedures, between patient procedures,daily, or at any other predetermined intervals. For example, in certaininstances the disinfectant may be applied (e.g., to the target surface)before, during (continuously or intermittently), or immediatelyfollowing patient procedures. The disinfectant (e.g., antibacterial orantiseptic agents) may consist of or include one or more of chlorinedioxide, stable chlorine dioxide, sodium chlorite (NaClO₂), peroxide,hydrogen peroxide, alkaline peroxides, iodine, providone iodine,peracetic acid, acetic acid, chlorite, sodium hypochlorite, citric acid,chlorhexidine gluconate, silver ions, copper ions, equivalents thereof,and combinations thereof.

In accordance with another aspect, disinfectant, such as a liquid in theform of mouthwash, may be used, for example, before, during(continuously or intermittently), or after procedures to decontaminate(e.g., provide an anti-microbial effect within) a surgical tissue site,which can be within a mouth of a patient. The disinfectant also may beused to clean tubes, which may be referred to as lines, that supply airand/or fluid as already described. The disinfectant may comprise, forexample, sodium chlorite (NaClO₂), chlorine dioxide, or stable chlorinedioxide alone or in combination with ions, such as silver ions. In otherembodiments, the disinfectant may comprise, for example, ions, such assilver, copper, or other ions.

According to another feature of the present invention, when disinfectantis routed through the lines before, during, and/or after a medicalprocedure, the disinfectant stays with the water or mist, as the wateror mist becomes airborne and settles (i.e., condenses) on a targettissue site or on surrounding surfaces, which may include adjacentequipment within a dental/medical operating room. Bacteria growth withinthe lines, and from the condensation, is thereby significantlyattenuated, since the disinfectant kills, stops and/or retards bacteriagrowth inside fluid (e.g., water) lines and/or on any moist surfaces.

The present invention, together with additional features and advantagesthereof, may best be understood by reference to the followingdescription taken in connection with the accompanying illustrativedrawings.

Any feature or combination of features described herein are includedwithin the scope of the present invention provided that the featuresincluded in any such combination are not mutually inconsistent as willbe apparent from the context, this specification, and the knowledge ofone of ordinary skill in the art. In addition, any feature orcombination of features described or referenced may be specificallyexcluded from any embodiment of the present invention. For purposes ofsummarizing the present invention, certain aspects, advantages and novelfeatures of the present invention are described or referenced. Ofcourse, it is to be understood that not necessarily all such aspects,advantages or features will be embodied in any particular implementationof the present invention.

Additional advantages and aspects of the present invention are apparentin the following detailed description and claims.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 illustrates a conventional dental/medical work station;

FIG. 2 is an example of one of many types of conventional optical cutterapparatuses;

FIG. 3 illustrates a dental/medical work station according to anembodiment of the present invention;

FIG. 4 is a schematic block diagram illustrating an electromagneticallyinduced disruptive cutter using conditioned fluid, according to oneembodiment of the present invention;

FIG. 5 a illustrates one embodiment of an electromagnetically induceddisruptive cutter of the present invention;

FIG. 5 b illustrates another embodiment of an electromagneticallyinduced disruptive cutter of the present invention;

FIG. 6 a illustrates a mechanical drilling apparatus according to animplementation of the present invention;

FIG. 6 b illustrates a syringe according to an implementation of thepresent invention;

FIG. 7 illustrates a fluid conditioning system according to anembodiment of the present invention;

FIG. 8 illustrates one embodiment of a fluid conditioning unit accordingto the present invention;

FIG. 9 illustrates an air conditioning unit according to an embodimentof the present invention;

FIG. 10 is a schematic block diagram illustrating an electromagneticallyinduced disruptive cutter according to an embodiment of the presentinvention;

FIG. 11 is an optical cutter having a focusing optic in accordance withan embodiment the present invention;

FIG. 12 illustrates a control panel for programming a combination ofatomized fluid particles according to an illustrative embodiment of thepresent invention;

FIG. 13 is a plot of particle size versus fluid pressure in accordancewith one implementation of the present invention;

FIG. 14 is a plot of particle velocity versus fluid pressure inaccordance with one implementation of the present invention;

FIG. 15 is a schematic diagram illustrating a fluid particle, a laserbeam, and a target surface according to an embodiment of the presentinvention;

FIG. 16 is a schematic diagram illustrating an “explosive grenade”effect according to an embodiment of the present invention;

FIG. 17 is a schematic diagram illustrating an “explosive ejection”effect according to an embodiment of the present invention;

FIG. 18 is a schematic diagram illustrating an “explosive propulsion”effect according to an embodiment of the present invention;

FIG. 19 is a schematic diagram illustrating a combination of FIGS.16-18;

FIG. 20 is a schematic diagram illustrating the “cleanness” of cutobtained by the present invention;

FIG. 21 is a schematic diagram illustrating the roughness of cutobtained by prior art systems;

FIG. 22 a depicts a sterile water controller adapted for use with anexisting Waterlase MBA or Waterlase MD system according to an embodimentof the present invention;

FIG. 22 b diagrams a sterile water kit suitable for use with an existingWaterlase MD system according to another embodiment of the presentinvention;

FIG. 23 is a block diagram of a sterile water controller according to anexemplary arrangement of the present invention;

FIG. 24 is a schematic diagram depicting a sterile water cassetteaccording to an implementation of the present invention; and

FIG. 25 is a schematic diagram depicting a sterile water cassetteaccording to another implementation of the present invention.

DETAILED DESCRIPTION OF THE INVENTION

Embodiments of the invention are now described and illustrated in theaccompanying drawings, instances of which are to be interpreted to be toscale in some implementations while in other implementations, for eachinstance, not. In certain aspects, use of like or the same referencedesignators in the drawings and description refers to the same, similaror analogous components and/or elements, while according to otherimplementations the same use should not. According to certainimplementations, use of directional terms, such as, top, bottom, left,right, up, down, over, above, below, beneath, rear, and front, are to beconstrued literally, while in other implementations the same use shouldnot. The present invention may be practiced in conjunction with variousdevices and techniques that are conventionally used in the art, and onlyso much of the commonly practiced process steps are included herein asare necessary to provide an understanding of the present invention. Thepresent invention has applicability in the field of laser devices andprocesses in general. For illustrative purposes, however, the followingdescription pertains to a laser cutting device.

An embodiment of a dental/medical work station 111 according to thepresent invention is shown in FIG. 3. Elements similar to those shown inFIG. 1 are preceded by a “1”. The illustrated embodiment of thedental/medical work station 111 comprises a conventional air line 113and a conventional biocompatible fluid (e.g., water) line 114 forsupplying air and water, respectively. As used herein, the term “water”is intended to encompass various modified embodiments of biocompatiblefluids such as distilled water, deionized water, sterile water, tapwater, carbonated water, and/or fluid (e.g., water) that has acontrolled number of colony forming units (CFU) per milliliter for abacterial count, and the like. For instance, drinking water is oftenchemically treated to contain no more than 500 CFU/ml and in some casesbetween 100 and 200 CFU/ml or even less, such as between 25 and 100CFU/ml. The embodiment shown in FIG. 3 further comprises a vacuum line112, an electrical outlet 115, and a dental/medical unit 116. The vacuumline 112 and electrical outlet 115 may supply, respectively, negativeair pressure and electricity to the dental/medical (e.g., dental ormedical) unit 116, providing functionality similar to that provided bythe vacuum line 12 and electrical outlet 15 shown in FIG. 1. Theembodiment still further can comprise a fluid conditioning unit 121 andinstruments 117. The fluid conditioning unit 121 is typically placedbetween the dental/medical unit 116 and the instruments 117, but may inother embodiments be placed (1) at, on or in the dental/medical unit116, (2) upstream of the dental/medical unit 116, (3) downstream of thedental/medical unit 116, or (4) at, on or in one or more of theinstruments 117, lasers 118/118 a or delivery systems 119/119 aAccording to exemplary implementations of the present invention, one ormore of the air line 113 and the biocompatible fluid (e.g., water) line114 may be provided and fluid conditioning may be introduced into one ormore of the provided lines 113 and 114. The line or lines to be providedwith fluid conditioning may connect to a fluid conditioning unit 121and/or may be provided with fluid conditioning using any other structureor method disclosed herein, such as a fluid-conditioning cartridge beingcoupled to the line or lines to thereby condition fluid passing throughthe line(s).

The embodiment likewise can comprise a controller 125 that may beconfigured to accept user inputs, which may control whether air from theair line 113, water from the biocompatible fluid (e.g., water) line 114,or both, are conditioned by the fluid conditioning unit 121. As usedherein, mentions of air and/or water are intended to encompass variousmodified embodiments of the invention, including various biocompatiblefluids used with or without the air, and/or water, and includingequivalents, substitutions, additives, or permutations thereof. Forinstance, in certain modified embodiments other biocompatible fluids maybe used instead of air and/or water. A variety of agents may be appliedto the air or water by the fluid conditioning unit 121, according to aconfiguration of the controller 125, for example, to thereby conditionthe air or water, before the air or water is output to thedental/medical unit 116. In one embodiment the air can be supplied froma nitrogen source instead of a regular air line. Flavoring agents andrelated substances, for example, may be used, as disclosed in 21 C.F.R.Sections 172.510 and 172.515, details of which are incorporated hereinby reference. Colors, for example, may also be used for conditioning,such as disclosed in 21 C.F.R. Section 73.1 to Section 73.3126, detailsof which are incorporated herein by reference.

Similarly to the instruments 17 shown in FIG. 1, the instruments 117 maycomprise an electrocauterizer, an electromagnetic energy source, forexample, a laser device, a mechanical drill, a sonic/ultrasonic device,a mechanical saw, a canal finder, syringe, an irrigator and/or anevacuator. The above instruments may be incorporated in a handpiece oran endoscope. All of these instruments 117 use air from the air line 113and/or fluid (e.g., water) from the biocompatible fluid line 114. Thebiocompatible fluid may or may not be conditioned depending on theconfiguration of the controller 125. Any of the instruments 117 mayalternatively be connected directly to the fluid conditioning unit 121or directly to any of the air line 113, biocompatible fluid line 114,vacuum line 112, and/or electrical outlet 115. The illustratedembodiment may comprise, for example, a laser device 118 and a deliverysystem 119 as shown in phantom connected to the fluid conditioning unit121. The embodiment further may comprise an alternative laser device 118a and an alternative delivery system 119 a that may be connected to thedental/medical unit 116 instead of being grouped with the instruments117. Any of the instruments 117 may be connected directly to any or allof the vacuum line 112, the air line 113, the biocompatible fluid line114 and the electrical outlet 115 and may have, for example, anindependent fluid conditioning unit (e.g., in the form of a cartridgethat intercepts and conditions fluid from one or more of the air line113 and the biocompatible fluid line 114). Instead or additionally, anyof these instruments 117 may be connected to the dental/medical unit 116or the fluid conditioning unit 121, or both.

A block diagram shown in FIG. 4 illustrates an exemplary embodiment of alaser device 51 that may be directly coupled with, for example, the airline 113 or with a line supplying another gas such as nitrogen,biocompatible fluid line 114, and electrical outlet 115 of FIG. 3. Aseparate fluid conditioning system is used in the embodiment illustratedin FIG. 4.

According to the exemplary embodiment shown in FIG. 4, anelectromagnetically induced disruptive (e.g., mechanical) cutter is usedfor cutting and/or coagulation. The laser device 51 (i.e. anelectromagnetic cutter energy source) is connected directly to theelectrical outlet 115 (FIG. 3), and is coupled to both a controller 53and a delivery system 55. The delivery system 55 routes and focuses alaser beam produced by the laser device 51. According to methodsassociated with a conventional laser system, thermal cutting forces maybe imparted onto a target 57 by the laser beam. In contrast, thedelivery system 55 of the present invention can comprise a fiberopticenergy guide for routing the laser beam into an interaction zone 59,located above a surface of the target 57. The exemplary embodiment ofFIG. 4 further includes a fluid router 60 that may comprise an atomizerfor delivering for example user-specified combinations of atomized fluidparticles into the interaction zone 59 continuously or intermittently.The atomized fluid particles and/or spray, jet, mist or nebulizer mist)fluids, which may absorb energy from the laser beam, thereby generatingdisruptive (e.g., cutting) forces as described below, may beconditioned, according to the present invention, and may compriseflavors, scents, medicated substances, disinfectant (e.g., antibacterialor antiseptic agents), saline, tooth-whitening agents, pigment particlesor other gaseous or solid particles (e.g., bio-ceramics, bio-glass,medical grade polymers, pyrolitic carbon, encapsulated water based gels,particles or water based gel particles encapsulated into microspheres ormicroparticles) and other actions or agents such as anticaries,antiplaque, antigingivitis, and antitartar agents in fluid or solid(e.g., tablet) form, as described below.

The delivery system 55 may include a fiberoptic energy guide orequivalent that attaches to the laser device 51 and travels to a desiredwork site. The fiberoptic energy guide (or waveguide) typically is tong,thin and lightweight, and is easily manipulated. The fiberoptic energyguides can be made of calcium fluoride (CaF), calcium oxide (CaO₂),zirconium oxide (ZrO₂), zirconium fluoride (Zrf), sapphire, hollowwaveguide, liquid core, TeX glass, quartz silica, germanium sulfide,arsenic sulfide, germanium oxide (GeO₂), and other materials. Otherimplementations of the delivery system 55 may include devices comprisingmirrors, lenses and other optical components whereby the laser beamtravels through a cavity, is directed by various mirrors, and is focusedonto the targeted tissue site with specific lenses.

A stream or mist of conditioned fluid may be supplied by the fluidrouter 60. The controller 53 may control the conditioning of the fluidfrom the fluid router 60 and specific characteristics of the fluid fromthe fluid router 60, as well as various operating parameters of thelaser device 51

Although the present invention may be used with conventional devices andinstruments such as: drills and lasers, for example, an illustrativeembodiment includes the above-mentioned electromagnetically induceddisruptive cutter. Other embodiments include an electrocauterizer,sonic/ultrasonic device, a syringe, an irrigator, an evacuator, or anyair or electrical driver, drilling, filling, or cleaning mechanicalinstrument.

FIG. 10 is a block diagram, similar to FIG. 4 as discussed above,illustrating one electromagnetically induced disruptive cutter of thepresent invention. The block diagram may be identical to that disclosedin FIG. 4 except that the fluid router 60 may not be necessary. As shownin FIG. 10, an electromagnetic energy source, for example, a laserdevice 351, which may produce a laser beam 350 (FIGS. 15-18) is coupledto both a controller 353 and a delivery system 355. The delivery system355 imparts disruptive and/or cutting forces onto a target surface 357.In one implementation, the delivery system 355 comprises a fiberopticguide 23 (FIG. 5 b, infra) for routing the laser beam 350 through anoptional interaction zone 359 and toward the target surface 357.

Referring to FIG. 11, an optical cutter according to one aspect of thepresent invention is shown, comprising, for example, many conventionalelements found in the prior-art electromagnetic cutter illustrated inFIG. 2. The illustrated embodiment comprises a first fiber guide tube205 that abuts within a cylindrical metal object 219. The first fiberguide tube 205 normally carries laser energy in a typical operatingmode. The embodiment further comprises a cap 231, a portion of whichcomprises another cylindrical metal object 221. The optical cutterillustrated in FIG. 11 comprises a focusing optic 235 disposed betweenthe two metal cylindrical objects 219 and 221. The focusing optic 235prevents undesired dissipation of laser energy from the first fiberguide tube 205. Although shown coupling the first fiber guide tube 205with a second fiber guide tube 223 with the first and second fiber guidetubes 205 and 223 having optical axes disposed in a straight line, thefocusing optic 235 may be implemented/modified in other embodiments. Forexample, the focusing optic 235 may be employed to couple fiber guidetubes having non-parallel optical axes (e.g., two fiber guide tubeshaving perpendicularly aligned optical axes). According to anotherembodiment, the focusing optic 235 may facilitate rotation of one orboth of two fiber guide tubes about their respective optical axes. Yetanother embodiment of the focusing optic 235 may comprise one or more ofa mirror, a pentaprism, and/or other light directing or transmittingmedia. Specifically, laser energy from the first fiber guide tube 205dissipates slightly before being focused by the focusing optic 235. Thefocusing optic 235 focuses laser energy from the first fiber guide tube205 into the second fiber guide tube 223. Efficient transfer of laserenergy from the first fiber guide tube 205 to the second fiber guidetube 223 may vitiate any need for the conventional air knife coolingsystem 33, 39, 41 of FIG. 2, because inclusion of the focusing optic 235may result in dissipation of less laser energy than may occur in theabsence of a focusing optic. The first fiber guide tube 205 typicallycomprises a trunk fiberoptic, which can comprise any of the above-notedfiberoptic materials. In modified embodiments, any aspect of the presentinvention, in addition to being combinable with the embodiment of FIG.11, may be combined with a structure of a type illustrated in FIG. 2 andvarious modifications and equivalents thereof.

Intense energy may be emitted from the fiberoptic guide 223 as can begenerated from a coherent source, such as a laser device. In anillustrative embodiment, the laser device comprises an erbium, chromium,yttrium, scandium, gallium garnet (Er, Cr:YSGG) solid state laserdevice, which generates light having a wavelength in a range of 2.70 to2.80 μm. As presently embodied, this laser device has a wavelength ofapproximately 2.78 μm. Fluid, which may be emitted intermittently orcontinuously from a nozzle 71 (FIG. 5 b, infra) comprises water in anillustrative embodiment. Other fluids may be used and appropriatewavelengths of an electromagnetic energy source may be selected to allowfor high absorption by the fluid or other particles and substances.Other possible laser systems include an erbium, yttrium, scandium,gallium garnet (Er:YSGG) solid state laser device, which generateselectromagnetic energy having a wavelength in a range of 2.70 to 2.80μm; an erbium, yttrium, aluminum garnet (Er:YAG) solid state laserdevice, which generates electromagnetic energy having a wavelength of2.94 μm; a chromium, thulium, erbium, yttrium, aluminum garnet (CTE:YAG)solid state laser device, which generates electromagnetic energy havinga wavelength of 2.69 μm; an erbium, yttrium orthoaluminate (Er:YALO3)solid state laser device, which generates electromagnetic energy havinga wavelength in a range of 2.71 to 2.86 μm; a holmium, yttrium, aluminumgarnet (Ho:YAG) solid state laser device, which generateselectromagnetic energy having a wavelength of 2.10 μm; a quadrupledneodymium, yttrium, aluminum garnet (quadrupled Nd:YG) solid state laserdevice, which generates electromagnetic energy having a wavelength of266 nm; an argon fluoride (ArF) excimer laser device, which generateselectromagnetic energy having a wavelength of 193 nm; a xenon chloride(XeCl) excimer laser device, which generates electromagnetic energyhaving a wavelength of 308 nm; a krypton fluoride (KrF) excimer laserdevice, which generates electromagnetic energy having a wavelength of248 nm; and a carbon dioxide (CO₂) laser device, which generateselectromagnetic energy having a wavelength in a range of 9.0 to 10.6 μm.

The delivery system 355 of FIG. 10 can further comprise a fluid output,which may or may not differ from the fluid router 60 of FIG. 4. Inexemplary embodiments implementing a fluid output, water can be chosenas a preferred fluid because of its biocompatibility, abundance, and lowcost. The actual fluid used may vary as long as it is properly matchedto the wavelength, λ, of a selected electromagnetic energy source (e.g.,a laser device) meaning that the fluid is capable of partially or highlyabsorbing electromagnetic energy having a wavelength, λ, of the selectedelectromagnetic energy source. In various implementations of theconfiguration of FIG. 4, the fluid (e.g., fluid particles and/or othersubstances including, for example, anticaries, antiplaque,antigingivitis, and antitartar agents in fluid or solid (e.g., tablet)form) can be conditioned as already described. For instance, the fluidcan be conditioned to be compatible with a surface of the target 57. Inone embodiment, the fluid particles comprise water that is conditionedby for example mild chlorination and/or filtering to render the fluidparticles compatible (e.g., containing no harmful parasites) with atooth or soft tissue target surface in a patient's mouth. In otherimplementations, other types of conditioning may be performed on thefluid as discussed previously. The delivery system 355 can comprise anatomizer, a sprayer, mister or nebulizer mister for deliveringuser-specified combinations of atomized fluid particles into theinteraction zone 359. The controller 353 controls various operatingparameters of the laser device 351, and further controls specificcharacteristics of a user-specified combination of atomized fluidparticles output from the delivery system 355, thereby mediating cuttingeffects on and/or within the target 357.

FIG. 5 a shows another embodiment of an electromagnetically induceddisruptive cutter, in which a fiberoptic guide 61, an air tube 63, and afluid tube 65, such as a water tube, are placed within a hand-heldhousing 67. Although a variety of connections are possible, the air tube63 and water tube 65 can be connected to either the fluid conditioningunit 121 or the dental/medical unit 116 of FIG. 3. The fluid tube 65 canbe operated under a relatively low pressure, and the air tube 63 can beoperated under a relatively high pressure.

According to one aspect of the present invention, either the air fromthe air tube 63 or fluid from the fluid tube 65, or both, areselectively conditioned by the fluid conditioning unit 121 (FIG. 3) ascontrolled by the controller 125. In one implementation, laser energyfrom the fiberoptic guide 61 focuses onto a combination of air andfluid, from the air tube 63 and the fluid tube 65, at the interactionzone 59. Atomized fluid particles in the air and fluid mixture absorbenergy from the laser energy received from the fiberoptic tube 61. Theatomized fluid particles may then expand and explode. Explosive forcesfrom these atomized fluid particles can, in certain implementations,impart disruptive (e.g., mechanical) cutting forces onto a surface ofthe target 57 (FIG. 4).

Turning back to FIG. 2, a conventional optical cutter focuses laserenergy onto a target surface at an area A, for example, and incomparison, a typical embodiment of an electromagnetically induceddisruptive cutter of the present invention focuses laser energy into aninteraction zone B, for example. The conventional optical cutter usesthe laser energy directly to cut tissue, and in comparison, theelectromagnetically induced disruptive cutter of the present inventionuses the laser energy to expand atomized fluid particles to thus impartdisruptive cutting forces onto the target surface. The atomized fluidparticles and other particles (above, on the surface, or within thetarget) are heated, expanded, and cooled before or during contacting thetarget surface or while on or within the target. The prior art opticalcutter may use a large amount of laser energy to cut the area ofinterest, and also may use a large amount of water to both cool thisarea of interest and remove cut tissue.

In contrast, the electromagnetically induced disruptive cutter of thepresent invention can use a relatively small amount of fluid (e.g.,water) and, further, can use only a small amount of laser energy toexpand atomized fluid particles generated from the water. According tothe electromagnetically induced disruptive cutter of the presentinvention, additional water may not be needed to cool an area ofsurgery, since some of the exploded atomized fluid particles are cooledby exothermic reactions before or while they contact the target surface.Thus, atomized fluid particles of the present invention are heated,expanded, and cooled before contacting the target surface. Theelectromagnetically induced disruptive cutter of the present inventionis thus capable of cutting without charring or discoloration.

FIG. 5 b illustrates another embodiment of the electromagneticallyinduced disruptive cutter. An atomizer for generating atomized fluidparticles comprises a nozzle 71, which may be interchanged with othernozzles (not shown) for obtaining various spatial distributions of theatomized fluid particles, according to the type of cut desired. A secondnozzle 72, shown in phantom lines, may also be used. In a simpleembodiment, a user controls air and water pressure entering the nozzle71. The nozzle 71 is thus capable of generating, either intermittentlyor continuously, many different user-specified combinations of atomizedfluid particles and aerosolized sprays. The nozzle 71 is employed tocreate an engineered combination of small particles of a chosen fluid.The nozzle 71 may comprise several different designs including liquidonly, air blast, air assist, swirl, solid cone, etc. When fluid exitsthe nozzle 71 at a given pressure and rate, the fluid may be transformedinto particles of user-controllable sizes, velocities, and spatialdistributions. A cone angle may be controlled, for example, by changinga physical structure of the nozzle 71. As another example, variousnozzles 71 may be interchangeably placed on the electromagneticallyinduced disruptive cutter. Alternatively, a physical structure of asingle nozzle 71 may be changed.

The fiberoptic guide 23 (FIG. 5 b) may emit electromagnetic energyhaving an optical energy distribution that may be useful for achievingor maximizing a cutting effect of an electromagnetic energy source, suchas a laser device, directed toward a target surface. Ablating effectsand/or the cutting effect created by the electromagnetic energy mayoccur on or at the target surface, within the target surface, and/orabove the target surface. For instance, using desired optical energydistributions, it is possible to disrupt a target surface by directingelectromagnetic energy toward the target surface so that a portion ofthe electromagnetic energy is absorbed by fluid. The fluid absorbing theelectromagnetic energy may be on the target surface, within the targetsurface, above the target surface, or a combination thereof.

In certain embodiments, the fluid absorbing the electromagnetic energymay comprise water and/or may comprise hydroxyl (e.g., hydroxylapatite).When the fluid comprises hydroxyl and/or water, which may highly absorbthe electromagnetic energy, molecules within the fluid may begin tovibrate. As the molecules vibrate, the molecules heat and can expand,leading to, for example, thermal cutting with certain output opticalenergy distributions. Other thermal cutting or thermal effects may occurby absorption of impinging electromagnetic energy by, for example, othermolecules of the target surface. Accordingly, the cutting effects fromthe electromagnetic energy absorption associated with certain outputoptical energy distributions may be due to thermal properties (e.g.,thermal cutting) and/or to absorption of the electromagnetic energy bymolecules (e.g., water above, on, or within the target surface) thatdoes not significantly heat the target surface. The use of certaindesired optical energy distributions can reduce secondary damage, suchas charring or burning, to the target surface in embodiments, forexample, wherein cutting is performed in combination with a fluid outputand also in other embodiments that do not use a fluid output. Thus, forexample, another portion of the cutting effects caused by theelectromagnetic energy may be due to thermal energy, and still anotherportion of the cutting effects may be due to disruptive (e.g.,mechanical) forces generated by the molecules absorbing theelectromagnetic energy, as described herein.

Not only can cutting effects of an electromagnetically induceddisruptive cutter apparatus be facilitated and/or mediated by fluiddistributions above the target surface, as disclosed above, but thecutting effects may alternatively or additionally be facilitated and/ormediated by the absorption of electromagnetic energy by fluid on orwithin the target surface. In one embodiment of the apparatus, thecutting effects are mediated by effects of energy absorption by acombination of fluid located above the target surface, fluid located onthe target surface, and/or fluid located in the target surface. In oneembodiment, about 25% to 50% of the impinging electromagnetic energythrough fluid and fluid particles and impinges on the target surface. Aportion of that impinging energy can operate to cut or contribute todisruption and/or cutting of the target surface. In other embodimentsabout 10% to 25%, 50% to 80%, or 80% to 95% of the impinging energypasses through fluid and fluid particles and impinges onto the targetsurface. A portion of that impinging energy can operate to cut orcontribute to disruption and/or cutting of the target surface.

A filter may also be provided with the apparatus to modifyelectromagnetic energy transmitted from the electromagnetic energysource so that the target surface is disrupted in a spatially differentmanner at one or more points in time compared to electromagnetic energythat is transmitted to a surface without a filter. A spatial and/ortemporal distribution of electromagnetic energy may be changed inaccordance with a spatial and/or temporal composition of the filter. Thefilter may comprise, for example, fluid; and in one embodiment thefilter is a distribution of atomized fluid particles the characteristics(e.g., size, distribution, velocity, composition) of which can bechanged spatially over time to vary an amount of electromagnetic energyimpinging on the target surface. As one example, a filter can beintermittently placed over a target to vary the intensity of theimpinging electromagnetic energy, thereby providing a type of pulsedeffect. In such an example, a spray or sprays of fluid (e.g., water) canbe intermittently applied to intersect the impinging electromagneticenergy. As another example, the filter can be placed to intersect theimpinging energy continuously. In some embodiments, utilization of afilter for cutting of the target surface may be achieved with reduced,or with no, secondary heating/damage that may typically be associatedwith thermal cutting resulting from use of prior art lasers that do nothave a filter. The fluid of the filter can comprise, for example, water.Outputs from the filter, as well as other fluid outputs, energy sources,and other structures and methods disclosed herein, may comprise any ofthe fluid outputs and other structures/methods described in U.S. Pat.No. 6,231,567, entitled MATERIAL REMOVER AND METHOD, the entire contentsof which are incorporated herein by reference to the extent compatibleand not mutually exclusive.

In one embodiment, an output optical energy distribution includes aplurality of high-intensity leading micropulses (one of which may assumea maximum value) that impart relatively high peak amounts of energy. Theenergy is directed toward the target surface to obtain desireddisruptive and/or cutting effects. For example, the energy may bedirected into atomized fluid particles, as described above, and intofluid (e.g., water and/or hydroxide (OH) molecules) present on or inmaterial of the target surface, which, in some instances, can comprisewater, to thereby expand the fluid and induce disruptive cutting forcesto or a disruption (e.g., mechanical disruption) of the target surface.The output optical energy distribution may also include one or moretrailing micropulses after a maximum-valued leading micropulse that mayfurther help with removal of material. According to the presentinvention, a single large leading micropulse may be generated or,alternatively, two or more large leading micropulses may be generated.In accordance with one aspect of the present invention, relativelysteeper slopes of the micropulses and shorter durations of themicropulses may tower an amount of residual heat produced in thematerial.

The output optical energy distribution may be generated by a flashlampcurrent generating circuit that is configured to generate a relativelynarrow pulse having a duration on an order of 0.25 to 300 μs. Diodepumping technology, for example, also may be used to generate the outputoptical energy distribution. Additionally, a full-width half-maximum(half-max) value of the optical output energy distribution of thepresent invention can occur within 30 to 70 μs after pulse onset, forexample. For comparison, full-width half-max values of the prior arttypically occur within the first 250 to 300 μs after pulse onset.Employing a relatively high pulse repetition frequency that may range,for example, from about 1 Hz to about 100 Hz, and further employing arelatively large initial distribution of optical energy in a leadingportion of each pulse of the present invention, can result in relativelyefficient disruptive cutting (e.g., mechanical cutting). The outputoptical energy distributions of the present invention can be adapted forcutting, shaping and removing tissues and materials, and further can beadapted for imparting electromagnetic energy into atomized fluidparticles over a target surface, or into other fluid particles locatedon or within the target surface. The cutting effect obtained by theoutput optical energy distributions of the present invention can be bothclean and powerful and, additionally, can impart consistent cuts orother disruptive forces onto target surfaces.

By controlling characteristics of output optical energy, such as pulseintensity, duration, and number of micropulses, a device of the presentinvention, for example, an embodiment as illustrated in FIG. 5 b, can beadjusted to provide a desired treatment for multiple conditions. Inaddition, the energy emitted from the devices disclosed herein may beeffective to cut a target surface, as discussed above, but may also beeffective to remodel a target surface. For example, a surface of a toothcan be remodeled without removing any of the tooth structure. In oneembodiment, the output optical energy is selected to have propertiesthat are effective to make a surface of a tooth relatively harder andmore resistant to attack from acid or bacteria when compared to a levelof resistance extant before treatment with one or more of the devicesdisclosed herein. By making the tooth physically harder, it may becomemore difficult for bacteria to damage the tooth. Remodeling energy maybe particularly effective to inhibit and/or prevent dental carries. Inone embodiment, the output optical energy may include a pulse with arelatively longer duration than the pulse described herein that is usedfor cutting. The pulse may include a series of steep micropulses, asdiscussed herein, and a longer trail of micropulses where pulse energyis maintained at a desired level for extended periods of time. Inanother embodiment, two modes of operation may be utilized, such as, forexample, a first pulse as described above with one or more intensemicropulses, and a second pulse that has a relatively slower leading andtrailing slope. Two mode embodiments may be particularly useful whenboth cutting and remodeling are desired. Thus, by remodeling a surfaceof a tooth, including anterior and/or posterior surfaces, the tooth maybecome harder which may be conducive to preventing tooth decay.

Referring back to the figures, and in particular to FIG. 12, a controlpanel 377 for allowing user-programmability of atomized fluid particlesis illustrated. By changing the pressure and flow rates of fluid, forexample, a user can control characteristics of the atomized fluidparticles. These characteristics may influence absorption efficiency oflaser energy, and subsequent cutting effectiveness of anelectromagnetically induced disruptive cutter. The control panel 377 maycomprise, for example, a fluid particle size control 378, a fluidparticle velocity control 379, a cone angle control 380, an averagepower control 381, a repetition rate 382, and a fiber selector 383.

FIG. 13 illustrates a plot 385 of mean fluid particle size of atomizedfluid particles versus pressure through a nozzle, for example, thenozzle 71 (FIG. 5 b), of an embodiment of an electromagnetically induceddisruptive cutter. According to the plot 385, when the pressure throughthe nozzle 71 is increased, the mean fluid particle size of the atomizedfluid particles decreases. FIG. 14 is a chart depicting a plot 387illustrating influence of pressure on mean fluid particle velocity. Theplot 387 shows that the mean fluid particle velocity of the atomizedfluid particles increases with increasing pressure.

According to one implementation of the present invention, materials canbe removed from a target surface, at least in part by disruptive cuttingforces instead of by conventional thermal) cutting forces. In such animplementation, electromagnetic energy is used only to induce disruptiveforces onto the targeted material. Thus, the atomized fluid particlesreferred to above act as a medium for transforming electromagneticenergy generated by a laser device into disruptive (e.g., mechanical)energy required to achieve a disruptive cutting effect in accordancewith the present invention. The electromagnetic (e.g., laser) energy,itself, may not be directly absorbed by the targeted material. Thedisruptive (e.g., mechanical) interaction of the present invention canbe safer and faster than conventional laser cutting systems. In certainimplementations, negative thermal side-effects typically associated withconventional laser cutting systems can be attenuated or eliminated bythe present invention.

According to an exemplary operating mode of the electromagneticallyinduced disruptive cutter, the fiberoptic guide 23 (e.g., FIG. 5 b) canbe placed into close proximity of a target surface. The fiberoptic guide23, however, does not actually contact the target surface in thisexemplary operating mode. Rather, atomized fluid particles from thenozzle 71 are placed into the interaction zone 59 referenced above inconnection with, for example. FIGS. 5 a and 5 b. A purpose of thefiberoptic guide 23 can thus be to place laser energy deep into adistribution of fluid particles into close proximity of a target surfaceand into the interaction zone 59.

A feature of the present invention is the formation of the fiberopticguide 23 of sapphire. Regardless of the composition of the fiberopticguide 23, however, another feature of the present invention is acleaning effect on the fiberoptic guide 23 resulting from air and waterthat may be emitted from the nozzle 71 onto the fiberoptic guide 23.Applicants have found that this cleaning effect is optimal when thenozzle 71 is pointed somewhat directly at the target surface. Forexample, debris from the disruptive cutting can be removed by a sprayfrom the nozzle 71.

Additionally, applicants have found that pointing the nozzle 71 towardthe target surface can enhance cutting efficiency of the presentinvention. Each atomized fluid particle typically contains a smallamount of initial kinetic energy in a direction of the target surface.When electromagnetic energy from the fiberoptic guide 23 contacts anatomized fluid particle, a spherical exterior surface of the fluidparticle (e.g., a water particle) acts as a focusing lens to focus theelectromagnetic energy into an interior portion of the water particle.

FIG. 15 illustrates a fluid e.g., water) particle 401 having a side withan illuminated surface 403, a shaded side 405, and a particle velocity408. Electromagnetic energy, which may be a laser beam 350 generated by,for example, a laser device 351 (FIG. 10) focused directly on atomized,conditioned fluid particles as described above, may be absorbed by thefluid particle 401, causing an interior portion of the fluid particle401 to heat rapidly and to explode. This explosion, which is exothermic,cools remaining portions of the exploded fluid particle 401. Surroundingatomized fluid particles further enhance cooling of portions of theexploded fluid particle 401. The explosion of the fluid particle 401 maygenerate a pressure wave. This pressure wave, and portions of theexploded fluid particle 401 having increased kinetic energy, aredirected toward the target surface 407. These high-energy (e.g.,high-velocity) portions of the exploded fluid particle 401, incombination with the pressure wave, may impart strong, concentrated,disruptive (e.g., mechanical) forces onto the target surface 407.

These disruptive forces may cause the target surface 407 to break apartfrom the material surface through a “chipping away” action. The targetsurface 407 does not undergo vaporization, disintegration, or charring.The chipping away process (i.e., a cutting process) can be repeated bythe present invention until a desired amount of material has beenremoved from the target surface 407. Unlike prior art systems, certainimplementations of the present invention may not require a thin layer offluid on the target surface 407. In fact, while not wishing to belimited, a thin layer of fluid covering the target surface 407 may incertain implementations interfere with the above-described interaction(e.g., cutting) process. In other implementations, a thin layer of fluidcovering the target surface 407 may not interfere with theabove-described interaction e.g., cutting) process.

FIGS. 16, 17 and 18 illustrate various types of absorptions ofelectromagnetic energy by atomized fluid particles according to thepresent invention. The nozzle 71 (FIG. 5 b) can be configured to produceatomized sprays with a range of fluid (e.g., water) particle sizesnarrowly distributed about a mean value. A user input device forcontrolling cutting efficiency or a type of cut may comprise a simplepressure and flow rate gauge or may comprise a control panel 377 asshown in FIG. 12, for example. Receiving a user input for a highresolution cut, for example, may cause the nozzle 71 to generaterelatively small fluid particles. Relatively large fluid particles maybe generated in response to a user input specifying a low resolutioncut. A user input specifying a deep penetration cut may cause the nozzle71 to generate a relatively low density distribution of fluid particles,and a user input specifying a shallow penetration cut may cause thenozzle 71 to generate a relatively high density distribution of fluidparticles. If the user input device comprises the simple pressure andflow rate gauge, then a relatively low density distribution ofrelatively small fluid particles can be generated in response to a userinput specifying a high cutting efficiency. Similarly, a relatively highdensity distribution of relatively large fluid particles can begenerated in response to a user input specifying a low cuttingefficiency. Other variations are also possible.

These various parameters can be adjusted according to the type of cutand a type of tissue (e.g., hard tissue and soft tissue) being treatedin, for example, dental or medical applications. Hard tissues mayinclude, for example, tooth enamel, tooth dentin, tooth cementum, bone,and cartilage. Soft tissues, which embodiments of theelectromagnetically induced disruptive cutter of the present inventionalso may be adapted to eat, may include skin, mucosa, gingiva, muscle,heart, liver, kidney, brain, eye, and vessels as examples. Othermaterials appropriate to industrial applications that may be cut mayinclude glass and semiconductor chip surfaces, for example.

A user may also adjust a combination of atomized fluid particles exitingthe nozzle 71 to efficiently implement cooling and cleaning of thefiberoptic guide 23 (FIG. 5 b). According to an illustrative embodiment,the combination of atomized fluid particles may comprise distribution,velocity, and mean diameter, to effectively cool the fiberoptic guide23, while simultaneously keeping the fiberoptic guide 23 free ofparticulate debris, which may be introduced thereon from the targetsurface 357 (FIG. 10).

Referring again to FIG. 15, electromagnetic energy, for example, thelaser beam 350, typically contacts each atomized fluid particle 401 onthe illuminated surface 403 and penetrates the atomized fluid particle401 to a certain depth. The electromagnetic energy, which may be focusedinto an interior portion of the fluid (e.g., water) particle asdescribed above, may be absorbed by the fluid particle 401, therebyinducing explosive vaporization of the atomized fluid particle 401.

Diameters of atomized fluid particles, for example, the atomized fluidparticle 401 (FIGS. 15-18), can be less than, almost equal to, orgreater than the wavelength, λ, of the incident electromagnetic energycorresponding, respectively, to a first, second, and third case ofinterest, in each of these three cases, a different interaction mayoccur between the electromagnetic energy and the atomized fluid particle401. FIG. 16 illustrates the first case, wherein the diameter, d, of theatomized fluid particle 401 is less than the wavelength of theelectromagnetic energy (d<λ). This first case causes a complete volumeof fluid inside the fluid particle 401 to absorb the electromagnetic(e.g., laser) energy, thereby inducing explosive vaporization. The fluidparticle 401 explodes, ejecting its contents radially. Applicants referto this phenomenon as an “explosive grenade” effect. As a result of thisinteraction, radial pressure waves from the explosion are created andprojected in a direction of propagation of the electromagnetic energy.The direction of propagation is toward the target surface 407, and inone embodiment, both the electromagnetic (e.g., laser) energy and theatomized fluid particles are traveling substantially in the direction ofpropagation.

Explosion of the fluid particle 401 produces portions that, acting incombination with the pressure wave, produce a “chipping away” effect ofcutting and removing of materials from the target surface 407. Thus,according to the “explosive grenade” effect of the first case as shownin FIG. 16, a relatively small diameter of the fluid particle 401 allowselectromagnetic energy from the laser beam 350 to penetrate and to beabsorbed violently within an entire volume of the fluid particle 401.Explosion of the fluid particle 401 can be analogized to an explodinggrenade, which radially ejects energy and shrapnel. Water content of thefluid particle 401 may be vaporized due to strong absorption within asmall volume of fluid, and the pressure waves created during thisprocess produce the cutting process, which may remove material.

FIG. 17 illustrates the second case introduced above, wherein the fluidparticle 401 has a diameter, d, approximately equal to the wavelength ofthe electromagnetic energy (d≈λ). According to this second case, an“explosive ejection” effect may be produced, according to which theelectromagnetic (e.g., laser energy travels through the fluid particle401 before becoming absorbed by the fluid therein. Once theelectromagnetic energy is absorbed, the shaded side of the fluidparticle heats up, and explosive vaporization occurs. In this secondcase, internal particle fluid is violently ejected through the fluidparticle's shaded side, and the ejected fluid moves rapidly with theexplosive pressure wave referenced above toward the target surface. Asshown in FIG. 17, the electromagnetic (e.g., laser) energy is able topenetrate the fluid particle 401 and to be absorbed within a depth doseto the size of the diameter of the fluid particle 401. A center ofexplosive vaporization in the second case illustrated in FIG. 17 iscloser to the shaded side 405 of the moving fluid particle 401.According to this “explosive ejection” effect shown in FIG. 17, thevaporized fluid is violently ejected through the shaded side of theparticle toward the target surface 407.

A third case introduced above and shown in FIG. 18 generates an“explosive propulsion” effect. In this third case, the diameter, d, ofthe fluid particle is larger than the wavelength of the electromagnetic(e.g., laser) energy (d>λ). The electromagnetic (e.g., laser) energy inthis third case, penetrates the fluid particle 401 only a small distancethrough the illuminated surface 403 causing this illuminated surface 403to vaporize. The vaporization of the illuminated surface 403 tends topropel a remaining portion of the fluid particle 401 toward the targetsurface 407. Thus, a portion of mass of the fluid particle 401 gainskinetic energy, thereby propelling a remaining portion of the fluidparticle 401 toward the target surface 407 with a high kinetic energy.This high kinetic energy is additive to the initial kinetic energy ofthe fluid particle 401. The effects shown in FIG. 18 can be visualizedas a micro-hydro rocket having a jet tail, which helps to propel thefluid particle 401 with high velocity toward the target surface 407.Exploding vapor on a side having the illuminated surface 403 thussupplements a velocity corresponding to the initial kinetic energy ofthe fluid particle 401.

A combination of FIGS. 16-18 is shown in FIG. 19. The nozzle 71 (seealso FIG. 5 b) produces a combination of atomized fluid particles thatare transported into the interaction zone 59. In some embodiments, thelaser beam 350 (FIGS. 15-18) can be focused (intermittently orcontinuously) on this interaction zone 59. Relatively small fluidparticles 431 vaporize according to the explosive grenade effectdescribed above, and relatively large fluid particles 433 explode viathe “explosive propulsion” effect likewise described above. As furtherdescribed above, medium sized fluid particles, having diametersapproximately equal to the wavelength of the electromagnetic energy(e.g., the laser beam 350) and shown by the reference number 435,explode via the explosive ejection” effect. Resulting pressure waves 437and exploded fluid particles 439 impinge upon the target surface 407.

FIG. 20 illustrates the clean, high resolution cut which can be producedby the electromagnetically induced disruptive (e.g., mechanical) cutterof the present invention. Unlike some cuts of the prior art that may begenerated such as shown for example in FIG. 21, the cut of the presentinvention can be clean and precise. Among other advantages, the cut ofthe present invention can provide one or more of an ideal bondingsurface, accuracy, and attenuation of stress on remaining materialssurrounding the cut.

An illustrative embodiment of a structure for light delivery, forexample, for delivery of the laser beam 350 (FIGS. 15-18), for medicalapplications of the present invention is through a fiberoptic conductor,for example, the fiberoptic guide 223 illustrated in FIG. 11, because ofits light weight, relatively low cost, and ability to be packaged insideof a handpiece of familiar size and weight to a surgeon, dentist, orclinician. Non-fiberoptic systems may be used in both industrialapplications and medical applications, as well. As described above withreference to FIG. 3, the collection of instruments 117 may comprise amechanical drill. An example of such a mechanical drill 160 is shown inFIG. 6 a, comprising a handle 62, a drill bit 64, and a water output 66.The mechanical drill 160 comprises a motor 68, which may be electricallydriven, or which may be driven by pressurized air.

When the motor 68 is driven by air, for example, a fluid may enter themechanical drill 160 through a first supply line 70. Fluid enteringthrough the first supply line 70 passes through the motor 68, which maycomprise a turbine, for example, to thereby provide rotational forces tothe drill bit 64. A portion of the fluid, which may not appeal to apatient's taste and/or smell, may exit around the drill bit 64, cominginto contact with the patient's mouth and/or nose. The majority of thefluid exits back through the first supply line 70.

When the motor is electrically driven, for example, the first supplyline 70 provides electric power. A second supply line 74 supplies fluidto a fluid output 66. The water and/or air supplied to the mechanicaldrill 160 may be selectively conditioned by a fluid conditioning unit,for example, the fluid conditioning unit 121 illustrated in FIG. 3,according to a configuration of a controller, for example, thecontroller 125 likewise illustrated in FIG. 3.

The instruments 117 (FIG. 3) further may comprise a syringe 76 as shownin FIG. 6 b. The illustrated embodiment of a syringe 76 comprises an airinput line 78 and a water input line 80. A user control 82 is movablebetween a first position and a second position. The user control 82,when placed into the first position, causes air from the air input line78 to be supplied to an output tip 84. When the user control 82 isplaced in the second position, water is supplied from the water line 80to the output tip 84. Either the air from the air line 78, the waterfrom the water line 80, or both, may be selectively conditioned by afluid conditioning unit, for example, the fluid conditioning, unit 121of FIG. 3, according to the configuration of the controller 125 (FIG.3), for example. In modified embodiments, the fluid conditioning unit121 may be provided in a form of a cartridge or cartridges that can becoupled to one or more of an existing air line, water line, or air/waterline, to thereby provide fluid conditioning thereto, wherein thecartridge or cartridges can be coupled at any point on the air and/orwater line from a source end where the air and/or water is provided intoa room to where the air and/or water is output onto an operation site.

Turning to FIG. 7, a portion of an embodiment of the fluid conditioningunit 121 (FIG. 3), which may be provided, for example, in the form of aremovable cartridge, is shown. The illustrated embodiment of the fluidconditioning unit 121 can be adaptable to an existing fluid line orlines (e.g., air, water and/or air/water lines), such as an existingwater line 114 (FIG. 3), for providing conditioned fluid to thedental/medical unit 116 as a substitute for regular tap water indrilling and cutting operations, for example. An interface 89 mayconnect to an existing fluid line, such as an existing water line 114,and may feed fluid (e.g., water) through a fluid-in line 81 and a bypassline 91. The fluid conditioning unit 121 may include a reservoir 83 thataccepts water from the fluid-in line 81 and outputs conditioned fluid toa fluid-out line 85. The fluid-in line 81, the reservoir 83, and thefluid-out line 85 together comprise a fluid conditioning subunit 87 inthe form of, for example, a cartridge that can be connected to anexisting line or lines.

In an illustrated embodiment as shown in FIG. 7, conditioned fluid isoutput from the fluid conditioning subunit 87 into a combination unit93. The fluid may be conditioned by conventional means, such as additionof a tablet, liquid syrup, or a flavor cartridge. Also input into thecombination unit 93 is regular water from the bypass line 91.Conditioned fluid may exit the combination unit 93 through a fluid tube65. A user input 95 into the controller 125 (FIG. 3), for example,determines whether fluid output from the combination unit 93 into thefluid tube 65 comprises only conditioned fluid from the fluid-out line85, only regular water from the bypass line 91, or a combinationthereof. The user input 95 may comprise, as examples, a push button, atouch screen, a rotatable knob, a pedal, or a foot switch, or the like,operable by a user, for determining proportions and amounts ofconditioned and/or non-conditioned fluid (e.g., water). Theseproportions may be determined according to a position of the pedal orknob position or ranges programmed on the screen, for example. In theembodiment comprising a pedal, for example, a full-down pedal positionmay correspond to only conditioned fluid from the fluid-out line 85being output into the fluid tube 65, and a full pedal up position maycorrespond to only water from the bypass line 91 being output into thefluid tube 65. In another configuration, the switching between modes andamount of fluid conditioned or non-conditioned delivered to the site canbe accomplished through controls on the touch screen (e.g., push buttonsor touch buttons). In yet another configuration, mode switching andselection of a fluid type may be voice activated. One or more of thebypass line 91, the combination unit 93, and the user input 95 mayprovide versatility, but may be omitted, according to preference. Asimple embodiment for conditioning fluid comprises only the fluidconditioning subunit 87. Thus, in certain implementations of any of theembodiments described herein, one or more of the bypass line 91 and thecombination unit 93 may be omitted. For example, a cartridge may becoupled to an existing line to inject conditioning agents into theexisting line, wherein the cartridge does not include a bypass line 91or a combination unit 93.

An alternative embodiment of the fluid conditioning subunit 87 (FIG. 7)is shown in FIG. 8 identified by reference designator 187. The fluidconditioning subunit 187 may input air from an air line 113 (FIG. 3),which may connect to an air input line 181. Conditioned fluid may beprovided via a fluid output line 185. The fluid output line 185 canextend vertically down into a reservoir 183 and into a fluid 191 locatedtherein. A lid 184 of the reservoir 183 may be removed, and conditionedfluid may be inserted into the reservoir 183. Alternatively, aconditioning substance such as anticaries, antiplaque, antigingivitis,and antitartar agents, in a form of a solid (e.g., a tablet or capsule)or liquid form of fluid conditioner may be added to water already in thereservoir 183. In any case, the solid may release the conditioningsubstance either slowly or quickly into the fluid depending on theapplication. In one embodiment the solid is an effervescent tablet whichcan dissolve and mix with fluid at the same time. The fluid can also beconditioned, using a scent, a flavor, an antiseptic, an antibacterial, adisinfectant, or a medication. The medication may take a form of a fluiddrop or a tablet (not shown). The fluid 191 further may be supplied withfungible cartridges, for example. The entire reservoir 183 may bedisposable or replaceable to accommodate the aforementioned fluidconditioners or different disinfectants, antiseptics, antibacterials,vitamins, flavors or medications.

The fluid 191 within the reservoir 183 may be conditioned to achieve adesired flavor, such as a fruit flavor or a mint flavor, or may beconditioned to achieve a desired scent, such as an air freshening smell.In one embodiment wherein the fluid 191 in the reservoir 183 isconditioned to achieve a desired flavor, a flavoring agent for achievingthe desired flavor does not consist solely of a combination of salineand water and does not consist solely of a combination of detergent andwater. Conditioning the fluid 191 to create ascent, a scented mist, or ascented source of air, may be particularly advantageous forimplementation in connection with an air conditioning unit, as shown inFIG. 9 and as described below. In addition to flavor and scents, otherconditioning agents may be selectively added through a conventionalwater line, mist line, or air line, for example, air line 113 and/orwater line 114 as illustrated in FIG. 3. For example, an ionizedsolution, such as saline water, or a pigmented or particulate solution(containing for example bio-ceramics, bio-glass, medical grade polymers,pyrolitic carbon, encapsulated water based gels, particles or waterbased gel particles encapsulated into microspheres or microparticles)may be added. Additionally, agents may be added to change a density,specific gravity, pH, temperature, or viscosity of water and/or airsupplied to a drilling or cutting operation. These agents may include atooth-whitening agent for whitening a tooth of a patient. Thetooth-whitening agent may comprise, for example, a peroxide, such ashydrogen peroxide, urea peroxide, carbamide peroxide or any other agentsknown to whiten. The tooth-whitening agent may have a viscosity on anorder of about 1 to 15 centipoises (cps). Medications, such asantibiotics, steroids, anesthetics, anti-inflammatories, disinfectants,adrenaline, epinephrine, or astringents may be added to the water and/orair used in a therapeutic, drilling, or cutting operation. In oneembodiment the medication does not consist solely of a combination ofsaline and water and does not consist solely of a combination ofdetergent and water. For example, an astringent may be applied to asurgical area via the water line 114 (FIG. 3) to reduce bleeding.Vitamins, herbs, or minerals may also be used for conditioning air orwater used before, during (continuously or intermittently), or after atherapeutic, cutting or drilling procedure. An anesthetic oranti-inflammatory introduced into a conditioned fluid and applied to asurgical wound may reduce discomfort to a patient or trauma to thewound, and application of an antibiotic or disinfectant before, during(continuously or intermittently) or after a procedure may preventinfection to the wound.

An air conditioning subunit connectable into an existing air line 113(FIG. 3) via interfaces 286 and 289 is illustrated in FIG. 9. The airconditioning subunit may comprise an air input line 281, a reservoir283, and an air output line 285. Conventional air from, for example, airline 113 enters the air conditioning subunit via the air input line 281,which may be connected to the air line 113, and exits through the airoutput line 285. The air input line 281 can extend vertically into thereservoir 283 and into a fluid 291 within the reservoir 283. The fluid291 can be conditioned, using either a scent fluid drop or a scenttablet (not shown). The fluid 291 may be conditioned with other agents,as discussed above in the context of conditioning water. According tothe present invention, water in the water line 31 or air in the air line32 of a conventional laser cutting system (FIG. 2) may also beconditioned. Either or both of the fluid tube 65 and the air tube 63(FIG. 5 a) of an electromagnetically induced disruptive cutter may beconditioned as well. In addition to laser operations, air and/or waterof a dental cleaning, whitening, irrigating, suction, electrocautery, orsonic/ultrasonic system may also be conditioned.

Many of the above-discussed conditioning agents may change absorptionsof electromagnetic energy by atomized fluid particleselectromagnetically induced disruptive (e.g., mechanical) cuttingenvironments as described herein. Accordingly, a type of conditioningmay affect the cutting power of an electromagnetic or anelectromagnetically induced disruptive cutter. Thus, in addition todirect benefits achievable by incorporation of various conditioningagents discussed above, such as flavor, disinfectants, antiseptics,medication, etc., these various conditioning agents further provideversatility and programmability to the type of cut resulting from use ofthe electromagnetic or electromagnetically induced disruptive cutter.For example, introduction of a saline solution may change the speed ofcutting. Such a biocompatible solution may be used for delicate cuttingoperations or, alternatively, may be used with a variable laser powersetting to approximate or exceed the cutting power achievable withregular water.

Pigmented and/or particulate fluids may also be used with theelectromagnetic or the electromagnetically induced disruptive cutteraccording to the present invention. An electromagnetic energy source maybe set for maximum absorption of atomized fluid particles having acertain pigmentation, for example. These pigmented atomized fluidparticles may then be used to achieve disruptive cutting. A second wateror mist source may be used in a cutting operation. When water or mistfrom this second water or mist source is not pigmented, the interactionwith the electromagnetic energy source may be minimized. As just oneexample of many, water or mist produced by the secondary mist or watersource could be flavored.

According to another configuration, the atomized fluid particles may beunpigmented and/or nonparticulate, and an energy source for theelectromagnetic or the electromagnetically induced disruptive cutter maybe set to provide maximum energy absorption for these unpigmentedatomized fluid particles. A secondary pigmented fluid or mist may thenbe introduced into the surgical area, and this secondary mist or waterwould not interact significantly with electromagnetic energy emitted bythe electromagnetic or the electromagnetically induced disruptivecutter. As another example, a single source of atomized fluid particlesmay be switchable between pigmentation and non-pigmentation, and anelectromagnetic energy source may be set to be absorbed by one of thetwo pigment states pigmented and unpigmented) to thereby provide adimension of controllability as to exactly when cutting is achieved.

In another embodiment, a source of atomized fluid particles may comprisea tooth whitening agent that is adapted to whiten a tooth of a patientas described above. The source of atomized fluid particles may beswitchable by a switching device (e.g., by the controller 125 of FIG. 3)between a first configuration, wherein the atomized fluid particlescomprise the tooth-whitening agent and a second configuration whereinthe atomized fluid particles do not comprise the tooth-whitening agent.In this embodiment, the electromagnetic or electromagnetically inducedenergy source may comprise, for example, a laser device that is operablebetween an on condition and an off condition, independently of theconfiguration of the switching device. Thus, regardless of whether theswitching device is in the first configuration or the secondconfiguration, the laser can be operated in either the on or offcondition.

Disinfectant (e.g., antibacterial, antiseptic and other such agents) maybe added to an air or fluid (e.g., water) source in order, for example,to combat bacteria growth within air and/or water lines (e.g., air line113 and water line 114 illustrated in FIG. 3) and to minimize bacteriaat a tissue site before, during and/or after treatment. Thedisinfectant, further, may minimize bacteria growth on surfaces adjacentto a location where a procedure is performed. Disinfectant may beapplied either continuously or intermittently. As used herein, the term“disinfectant” is intended to encompass various modified embodiments ofthe present invention, including those embodiments using disinfectantshaving one or more of chlorine dioxide, stable chlorine dioxide, sodiumchlorite, peroxide, hydrogen peroxide, alkaline peroxides, iodine,providone iodine, peracetic acid, acetic acid, chlorite, sodiumhypochlorite, hypochlorous acid, sodium chlorate, sodium percarbonate,citric acid, chlorohexidine gluconate, nitrate, silver ions, copperions, zinc ions, equivalents thereof, and combinations thereof,including those that may or may not include biocompatible base orcarrier mediums (e.g., water and other forms of water-based products forsurgical procedures).

A disinfectant may be introduced continuously or intermittently, forexample, into air, mist, or water used for a dental or medical (e.g.,surgical) procedure or application. For instance, in a context of afluid (e.g., water) line, the disinfectant may be introduced to reduceone or more of a biofilm content within the fluid line and/or abacterial count of a fluid supplied by the line. This disinfectant canbe periodically routed through air, mist, or water lines to disinfectinterior surfaces thereof.

With reference to FIG. 3, for example, the air line 113 and water line114 of the dental/medical unit 116, for example, may be periodicallyflushed with a disinfectant. In one embodiment, the disinfectant may beselected by the controller 125 and supplied by the fluid conditioningunit 121. In the illustrated embodiment, an optional accessory tubedisinfecting unit 123 may accommodate disinfecting cartridges and mayperform standardized or preprogrammed periodic flushing operations.

A canister or cartridge (e.g., dispensing housing) may be placed todirectly access and teed components disinfectants and/or medicaments)into, for example, a fluid-conditioning air and/or water reservoir(c.f., 281 of FIG. 9 or 185 of FIG. 8) or to directly access and feedcomponents into fluid supply lines such as one or more of an existingair (c.f., 113 of FIG. 3), water (c.f., 114 of FIG. 3), or air/waterline, wherein the canister or cartridge may be disposed at any point(e.g., from a supply-line source to a handpiece output) along one ormore fluid supply lines of, for example, a conventional,non-conditioning medical or dental system). The canister or cartridge inone embodiment may be placed, for example, downstream of a reservoir, orreservoir location in embodiments without a reservoir, to feedcomponents to for example a handpiece output either continuously orintermittently. In exemplary implementations, the downstream placementmay include positioning a replaceable canister within the handpiece orsecuring the canister to an external surface of the handpiece, so thatwhen the handpiece emits fluid the canister may add a conditioningeffect. If, for example, an optional upstream reservoir is also used thedownstream placement may add a further conditioning effect to the fluid.According to an implementation wherein the canister or cartridge isdisposed adjacent to or within, for example, a laser handpiece, removalof the handpiece from a trunk fiber assembly can provide access to thecanister or cartridge for maintenance or replacement. Any conditioningagent, such as, for example, medications, disinfectants (antibacterialand antiseptic agents), flavors, remedies, or vitamins may be applied toa tissue site from, for example, a cartridge or cassette disposed withina handpiece or endoscope according to assorted embodiments of thepresent invention. In certain embodiments, the cartridge or cassette maybe located adjacent to the handpiece or endoscope. Each of theseembodiments may allow a correct dose of a fluid conditioning agent(solid or liquid) to be applied to an air or water line or appliedthrough an optional bypass line (e.g., bypass line 91 (FIG. 7)) andthereby to be delivered to a tissue/treatment site. Such a conditioningagent may also be applied as part of a sterile water system connected toa surgical/treatment handpiece or endoscope.

Positions of the canister or cartridge and reservoir may be swapped, orpositions of the canister or cartridge and reservoir may be madesubstantially the same, relative to an upstream or downstream location.As a non-inclusive list of examples, with reference to FIGS. 5 a, 5 b,7, 8 and 9, a canister or canisters may be placed in, on, or inproximity to, one or more of an air tube 63 (FIGS. 5 a, 5 b), fluid tube65 (FIGS. 5 a, 5 b, 7), fluid-in line 81 (FIG. 7), reservoir 83 (FIG.7), fluid-out line 85 (FIG. 7), bypass line 91 (FIG. 7), combinationunit 93 (FIG. 7), air input line 181 (FIG. 8), reservoir 183 (FIG. 8),fluid output line 185 (FIG. 8), air input line 281 (FIG. 9), reservoir283 (FIG. 9), and air output line 285 (FIG. 9).

In modified embodiments implementing a reservoir, the position of thecanister or cartridge and reservoir can be made substantially the same,and the canister or cartridge and reservoir may be combined. Forexample, the canister may be removably placed outside, or within, thereservoir. In an implementation where the canister is placed within areservoir, which may contain a liquid (e.g., water), the canister canserve to time release predetermined amounts of, for example, silverions, vitamins, remedies, disinfectants, antiseptics, flavors ormedications into the liquid within the reservoir. The canister orcartridge may be disposed within the reservoir by, for example,attachment to an internal surface of the reservoir, and/or attachment toor around one or more elements positioned within the reservoir. Forinstance, in the embodiments of FIGS. 8 and 9 the canister or cartridgemay be disposed around or in-line with either the fluid output line 185(FIG. 8) or air input line 281 (FIG. 9).

According to one embodiment, the canister or cartridge is positioned andconfigured to release medicaments and/or disinfectant ions (to beembedded at predetermined concentrations) over a predetermined period oftime either continuously, intermittently, or both. As one embodiment, asupply source (e.g., canister) may be configured to feed disinfectantsubstances such as ions (e.g., silver ions) and/or vitamins, remediesand/or medications into a fluid (e.g., air supply line continuously orintermittently, for example, to supply a certain dose of ions and/ormedication for a given procedure or period of use.

In embodiments wherein multiple fluid outputs are used, one or more ofthe fluid outputs may be configured in accordance with the presentinvention to emit, continuously or intermittently, in gas, liquid orsolution (spray), a substance or quantity that differs in some respectfrom that emitted from another fluid output or outputs. According to animplementation comprising two fluid outputs, such as that depicted inFIG. 5 b, one of the fluid outputs may be configured to emit a substance(e.g., silver ions) that differs in, for example, concentration from theother fluid output. For example, one fluid output may emit the substancewith the other not emitting the substance. According to embodimentsincorporating greater numbers of fluid outputs, such as disclosed inU.S. Provisional Patent Application No. 60/538,200, filed Jan. 22, 2004and entitled ELECTROMAGNETICALLY INDUCED CUTTER AND METHOD, the entirecontents of which are incorporated herein by reference, one or more ofthe fluid outputs (e.g., nozzles) may be configured to emit,continuously or intermittently, in gas, liquid or solution (spray), forexample, a substance than has a greater disinfecting, cosmetic and/ormedicating property than that emitted from the other fluid output oroutputs.

Routing of disinfectant can be performed between patient procedures,daily, or at any other predetermined intervals. For example, in certaininstances the disinfectant may be applied before, during (continuouslyor intermittently) or immediately following patient procedures, whereinconcentrations of disinfectant may be varied accordingly

In embodiments wherein one or more fluid outputs is/are used, a givenone or more of those fluid outputs may be configured in accordance withthe present invention to emit, continuously, or intermittently, in gas,liquid and/or solution (e.g., spray), a substance or quantity thatdiffers in some respect from that emitted from (a) another fluid outputor outputs and/or (b) the given fluid output or outputs at another pointin time. A given fluid output may be configured to emit a substance(e.g., silver ions) that differs in, for example, one or more ofquantity, composition, or concentration from an emission of the givenfluid output at a prior or subsequent point in time. For example, agiven fluid output may be configured to emit, continuously orintermittently, in gas, liquid or solution (spray), a substance than hasa greater disinfecting, cosmetic and/or medicating property than thatemitted from the given fluid output at a different (e.g., immediatelypreceding or following) point in time when the given fluid output isemitting the same or the same type (e.g., similar but not identical inone or more properties, or substantially identical) of substance oroutputs.

The disinfectant, antiseptic and/or antibacterial may consist of orinclude one or more of chlorine dioxide, stable chlorine dioxide, sodiumchlorite, peroxide, hydrogen peroxide, alkaline peroxides, iodine,providone iodine, peracetic acid, acetic acid, chlorite, sodiumhypochlorite, citric acid, chlorohexidine gluconate, disinfectant ions(e.g., silver ions, copper ions and zinc ions), equivalents thereof, andcombinations thereof which may or may not include biocompatible base orcarrier mediums (e.g., water). Exemplary concentrations (by volume) ofthe above-listed items may be chosen as listed in Table 1 when used, forexample, between procedures.

TABLE 1 Lower Upper Disinfectant limit Limit Typical Chlorine dioxide0.099%  0.9%  Stable chorine dioxide Sodium chlorite Hydrogen peroxide 0.1% 30% 4.6% Alkaline peroxides  0.1% 30% 4.6% Providone iodine  0.1%15% Peracetic acid 0.05%  6% 0.08%, 4.5% Acetic acid 0.01% 10% 6.5%Chlorite  0.1%  2% 0.4%-0.6% Sodium hypochlorite  0.1%  5% Hypochlorousacid 0.01% 0.1%  Sodium chlorate 0.0002%  0.002%   Bio-compatiblealcohol 0 25% Citric acid   1% 75% Chlorohexidine gluconate 0.05% 20%Silver ions 0.9 mg 2 mg Fluoride ions 0.15% 0.5%  Copper ions * * * Zincions * * * * Use in quantities recommended as acceptable by theEnvironmental Protection Agency (EPA)When used, for example, during procedures, item concentrations (byvolume) may be chosen as listed in Table 2.

TABLE 2 Lower Upper Disinfectant Limit Limit Example Chlorine dioxide 0.001% 0.099%  Stable chorine dioxide Sodium chlorite Hypochlorous acid0.0001% 0.009%  Silver nitrate 0 0.6% Eucalyptol 0 0.9% Menthol 0 0.5%Thymol 0 0.,7%  Bio-compatible alcohol 0  12% Chlorohexidine gluconate  .05%  20% 0.12% Silver ions 0.0015 mg 0.9 mg Fluoride ions 0.0001%0.15%  Sodium fluoride 0.05% or 0.2% or 225 ppm 990 ppm Stannousfluoride 0.1% or 0.4% or 244 ppm 1000 ppm Copper ions * * * Zincions * * * * Use in quantities recommended as acceptable by theEnvironmental Protection Agency (EPA)Regarding the exemplary concentrations set forth above, and in thecontext of any implementations described herein, wherein for examplefluids having different fluid properties (e.g., quantities,compositions, or concentrations) are output by one or more of (a) thesame fluid output at different times or (b) different fluid outputs atthe same or different times, the different fluid properties may beachieved by way of operation of a controller (e.g., controller 125 ofFIG. 3) and/or by operation of a user, for example, switching betweenone or more fluid-conditioning, canisters or cartridges.

According to a typical implementation, a first fluid conditioningcartridge may be coupled to a fluid (e.g., water) supply line using anymeans recognizable as suitable by those skilled in the art, to deliver afirst conditioning agent, such as a disinfectant at an in-procedureconcentration. The concentration provided by the first fluidconditioning cartridge to the fluid supply line may be altered using anymeans suitable for achieving such an effect, such as by operation of acontroller 125 under the influence of a pre-programmed or real-timeinput. In other implementations, the concentration provided by the firstfluid conditioning cartridge to the fluid supply line may be maintainedsubstantially constant for so long as the first fluid conditioningcartridge remains connected to the fluid supply line, which can be onlyduring a procedure or for the duration of a day, week, month, and thelike.

A second fluid conditioning cartridge may be coupled to the fluid supplyline using any means recognizable as suitable by those skilled in theart, to deliver a second conditioning agent, such as a disinfectant at abetween-procedures concentration. For example, in one implementation thefirst fluid conditioning cartridge for delivering the first conditioningagent may be decoupled from a point on the fluid supply line and thesecond fluid conditioning cartridge (e.g., having a similar constructionand/or connecting structure) may be coupled to the fluid supply line atthe same point. In accordance with another implementation, the secondfluid conditioning cartridge may be coupled to the first fluidconditioning cartridge or to the fluid supply line while the first fluidconditioning cartridge remains connected thereto. Operation of eitherone of the first fluid conditioning cartridge and the second fluidconditioning cartridge, or combinations of both, may be selected byoperation of a controller, by manual action from a user, bypre-programming, by an input from a user, or by combinations thereof.

The concentration provided by the fluid conditioning cartridge to thefluid supply line may be altered using any means suitable for achievingvariances in fluid concentrations, such as by operation of a controller125 under the influence of a pre-programmed or real-time input. In otherimplementations, the concentration provided by the fluid conditioningcartridge to the fluid supply line may be maintained substantiallyconstant for so long as the fluid conditioning cartridge remainsconnected to the fluid supply line, which can be only during a procedureor for the duration of a day, week, month, and the like.

One exemplary implementation may comprise a laser system with a firstconditioning cartridge connected to, for example, a fluid (e.g., water)supply line for the deliverance of a first conditioning agent (e.g., anin-procedure concentration of disinfectant) during procedures throughoutthe day.

According to certain implementations, the first conditioning agent canbe delivered throughout the day (e.g., continuously so that all fluid,such as water, that is drawn from the fluid supply line is conditioned)regardless of whether or not a given procedure or type of procedure isbeing performed. In other implementations, the first conditioning agentis delivered only during procedures o/at selected (e.g., predeterminedor real-time selected) times under the control of, for example, one ormore of a past or present input, such as a user input, whereby, forexample, the user can select a non-conditioned fluid (or a differentconcentration of fluid, or a fluid having one or more differentproperties) to be delivered at various times. At the end of the day (orat some other time, such as at the end of a procedure or the end of aweek) a connected first fluid conditioning cartridge may be decoupledfrom the fluid supply line with a second conditioning cartridge beingconnected thereto instead for the deliverance of a second conditioningagent (e.g., a between-procedures concentration of disinfectant) fordisinfecting equipment (e.g., the fluid supply line and/or other lines).A manual or automated disinfecting procedure may then be performed. At asubsequent point in time, such as the following morning, the secondfluid conditioning cartridge may be replaced with the, or another, firstfluid conditioning cartridge for the deliverance of the firstconditioning agent. At any point following the disinfecting procedure,such as at any time prior to a procedure, the lines that weredisinfected using the second fluid conditioning cartridge may be flushedor purged using, for example, a non-conditioned fluid or a fluidconditioned with the first conditioning agent.

For individuals with high risk for dental caries a higher percentage ofsodium fluoride is recommended during procedures. For example, about1.1% acidulated NaF (5000 ppm) or 1.1% neutral Naf (5000 ppm) can beused in certain embodiments. One or more of the concentrations listed inTables 1 and 2 may be effective in certain embodiments for facilitatingone or more of biofilm removal and viable count reduction of bacteria.In another embodiment an amount of stable chlorine dioxide or sodiumchlorite during patient treatment may be between 5 ppm to 150 ppm.Between procedures as a purge the amount may be between 50 ppm to 1,200ppm. Other ranges may include between 100 ppm to 150 ppm or morespecifically between 10 ppm to 300 ppm. Chlorine dioxide may be releasedfrom a two component system. In this case a first component may besodium chlorite, for example, and a second component may be an acid suchas citric acid, ascorbic acid vitamin C), phosphoric acid, carbonicacid, and lactic acid, as well as others.

The disinfectant (e.g., antibacterial or antiseptic agents) describedherein may be applied, either intermittently or continuously, during, orat or near completion of a medical or dental procedure. Air and waterused to cool and assist with tissue cutting or drilling within a mouthof a patient or at any other surgical site, for example, is oftenvaporized into the surrounding air to some degree. The air and wateralso may be projected onto a tissue target surface or onto adjacentinstrumentation. According to the present invention, a conditioneddisinfectant solution may also be vaporized with the air or water, andmay condense onto surfaces of the tissue target or onto adjacentdental/medical instruments and equipment within a dental/surgicaloperating room. Any bacteria growth on these moist surfaces may thus besignificantly attenuated as a result of a presence of the disinfectanton the surfaces. In accordance with another aspect, disinfectant (e.g.,antibacterial or antiseptic agents), such as a liquid or soliddissolvable in liquid, may be applied (e.g., sprayed), for example,during procedures (continuously or intermittently) to decontaminate(e.g., provide an anti-microbial effect on or within) an area ofinterest (e.g., a patient's mouth or surgical site) and/or clean the airand/or water tubes. The disinfectant may comprise one or more of forexample, chlorine dioxide or stable chlorine dioxide (sodium chloriteplus acid) or any other disinfectants, antibacterial or antisepticagents listed above or in combination with ions, such as silver,fluoride, copper, or zinc ions, equivalents thereof, and combinationsthereof including bio-compatible base or carrier mediums (e.g., waterand other surgical fluids). Other combinations my comprise adisinfectant (e.g., antibacterial or antiseptic agents) or medicament orflavor with one or more of the following substances: vitamin C (ascorbicacid), vitamin E, vitamin B₁ (thiamin), B₂ (riboflavin), B₃ (niacin), B₅(pantothenic acid), B₆ (pyridoxal, pyridoxamine, pyridoxine), B₁₂(cobalamine), biotin or B complex, bioflavonoids, folic acid, vitamin A,vitamin D, vitamin K, aloe vera, a natural anti-inflammatory,antioxidant or anti histamine remedy, and other such ingredients andsolutions. In other embodiments, the disinfectant may comprise, forexample, ions, such as silver, copper, or zinc ions, equivalentsthereof, and combinations thereof, which may or may not includebio-compatible base or carrier mediums (e.g., water).

While, according to certain aspects of the present invention, theabove-listed items can be used individually, other aspects of thepresent invention can comprise combinations of one or more of theabove-listed items with or without disinfectant ions. Other embodimentsmay comprise combinations of two or more of the above-listed items,wherein such combinations may be formed with or without disinfectantions. Concentrations of the above-listed items may be chosen as follows:

Chlorine dioxide (e.g., sodium chlorite plus acid), which may be desiredas a disinfectant for its affordability and efficacy, may be used duringthe aforementioned procedures at adequate concentrations without adverseside effects. That is, chlorine dioxide is relatively nontoxic at lowconcentrations and so can be used during procedures as well as, forexample, for purging lines between procedures. The chlorine dioxide canbe combined with, for example, silver ions (see acceptable range above).

A hydrogen peroxide based solution for disinfecting may be used alone orin combination with other disinfectants. For example, hydrogen peroxidemay be used in combination with peracetic acid (in concentrationsranging from about 0.05% to about 4%, e.g., 0.8% by volume when usedbetween procedures) or acetic acid (in concentrations from about 0.01%to about 10% by volume when used between procedures) or in combinationwith silver ions (see acceptable range above).

Sodium hypochlorite can be combined with, for example, citric acid (1%to 75% volume when used between procedures) and/or with disinfectantions.

According to another feature of the present invention, when disinfectantis routed in fluid through lines during a medical procedure, thedisinfectant stays with the fluid (e.g., water) or mist, as the water ormist becomes airborne and settles (i.e., condenses) on surroundingsurfaces within the dental operating room. Bacteria growth within thelines, and from the condensation, is significantly attenuated, becausethe disinfectant kills, stops and/or retards bacteria growth inside thefluid (e.g., water) lines and/or on any moist surfaces.

The introduction of disinfectant, antibacterial or antiseptic ions, maybe carried out for purposes including:

1) Disinfection of fluid lines, thereby reducing biofilm and/or keepingbacterial count low;

2) Decontamination (e.g. causing ions to act as an anti-microbialagents) of a tissue target that is being worked on (e.g., cut, ablated,or decontaminated) with, for example, a laser device prior to, during(continuously or intermittently) and/or at completion of a medicalprocedure, such as, (or example, irrigation with fluids (gas or liquid)during a laser procedure;

3) Projection of disinfectant ions onto a surface of targeted tissue(hard or soft) thereby temporarily or permanently embedding the ionsinto the surface or deeper into tissue in order to decontaminate ortreat the tissue. For example, ions such as fluorine ions may act tongterm as an anti-microbial agent or may perform other functions, such ascaries prevention;

4) Application at completion of a surgical procedure as ananti-microbial agent before a wound is closed or covered with arestorative material; and

5) To project and cover material (e.g., hard or soft tissue) or to embedinto material (e.g., hard or soft) compounds, ions or particles to coator attach to such material (e.g., hard or soft tissue) through surfacetension, adhesion, micromechanical retention and the like. Embedding mayinclude simultaneously remodeling of hard or soft tissue as disclosed inU.S. application Ser. No. 11/033,032, filed Jan. 10, 2005 and entitledELECTROMAGNETIC ENERGY DISTRIBUTIONS FOR ELECTROMAGNETICALLY INDUCEDDISRUPTIVE CUTTING, wherein benefits such as caries prevention and thelike along with ion benefits may be obtained, Other products used todecontaminate may include other types of ions such as Al, Ca, Ce, Mg,Sr, Sn or Ti. Such products are described in, for example, U.S. Pat. No.6,827,766 (e.g., see, for example, the abstract and Col. 2,122 to col.3,162), the entire contents of which are expressly incorporated hereinby reference. Stilt further, silver ions may be incorporated into wateror another type of fluid, or a colloidal solution (e.g., colloidalsilver aggregate) that contains silver particles may be used. Copper orzinc may or may not be used in place of silver in these instances.Silver particles (e.g., ions) can be about 20 Å, 10 Å, or less indiameter (e.g., about 8 Å in one embodiment). In another formulation, acolloidal silver aggregate can have zeta potential (i.e., can be formedas colloidal silver having a higher charge density (or concentration)than is normally obtained with a similar number of single silver ionsdispersed through a fluid). This type of colloidal silver aggregate hasbeen used for wound dressings or wound care. Silver can provideextremely small particle sizes for permeating cell (e.g., pathogen)membranes in order to accomplish a variety of antimicrobial actions(e.g., actions disabling a pathogen from reproducing).

With regard to the use of colloidal silver aggregate as a disinfectant,EPA recommendations should be followed where applicable. EPA studieshave shown that an amount of silver intake in order to be at risk forargyria (a permanent dark discoloration of skin caused by over use ofmedicinal silver preparations) is 3.8 to 6 grams of silver. According toanother EPA guideline, a critical daily dose of silver for a 160 poundadult is 1.09 mg. This dosage is below the critical daily intake for thedevelopment of argyria as recommended by the EPA. One teaspoon of 5 ppmcolloidal silver contains about 25 micrograms of silver, or 0.025milligrams of silver. Six teaspoons, the equivalent of one fluid ounce,therefore contains 0.15 milligrams of silver.

The FDA has approved antibacterial silver for food industryapplications. An article appearing athttp://www.silvermedicine.org/ag-ions-1.html reported that, AgIONSTechnologies incorporated received approval by the FDA in October 2003for use of antibacterial silver in the food industry. The FDA informedAgIONS Technologies that the product had been added to the FDA's list offood contact substances. The AgIONS Type AK product was comprised of 5%silver contained within an inert crystalline carrier. When subject tosmall amounts of moisture, AgIONS begin to release silver ions, whichthen act to eliminate bacterial growth on treated surfaces. AgIONS wasspecifically designed and engineered as a surface treatment system, withwide applications in the food processing industry. Since most foodprocessing plants have a zero tolerance policy for bacterial spoilage,the use of silver to treat surfaces and equipment used in foodprocessing was expected to greatly reduce bacterial growth.

One embodiment of the present invention uses only nontoxic silver saltscombined with fluid (e.g., water) as part of a fluid conditioningprocess as described herein.

Silver or other ions (e.g., copper, zinc, fluoride, etc.) may becombined with other disinfectants (e.g., chlorine dioxide, peroxides,and/or other medical/dental disinfectants, such as hypochloric acid),for disinfecting water lines. For antiseptic applications (i.e. forapplication to tissue), silver ions may be combined with antiseptics.The silver ions may operate to have combined action with radical oxygentoxic species (ROTS), examples of which may include peroxides (e.g.,hydrogen peroxide). ROTS also may be combined with antioxidants (e.g.,selenium or vitamin E) in some medical/dental applications.

U.S. Pat. No. 4,915,955 discloses a product used to disinfect dental(e.g., water and/or air) lines (e.g., purge water and/or air lines onetime), which may comprise, for example, hydrogen peroxide (5%) andsilver ions. A reprint from http://silverdata.20m.com/h2o2.html reportsthat “[a]ccording to Water and Science Technology, Volume 31 5-6, a1000:1, solution of colloidal silver to hydrogen peroxide is sufficientto increase the efficacy of colloidal silver by up to 100 times undersome circumstances (which may remain unknown) against bacterialinfections”

Water, including ingredients that may be preservatives (or have at leastpartial preservative properties) that imbue the water withbacteriostatic properties, may be employed in some embodiments.

Chemicals that may be incorporated into water in order to prevent growthof microorganisms (i.e., to introduce bacteriostatic properties into thewater) include:

-   -   1) Sodium chloride (NaCl);    -   2) Sugars such as sucrose, dextrose, and fructose;    -   3) Organic acids such as acetic acid (vinegar), lactic acid,        citric acid, propionic acid, ascorbic acid, benzoic acid (also        called benzoates);    -   4) Nitrates and nitrites; and    -   5) Oxides such as sulfur dioxide, ethylene oxide, and propylene        oxide.

According to an embodiment, fluid containing ions may be sprayed before,during (continuously or intermittently), and/or after tissue cutting,wherein, for example, the concentrations may differ at different times(e.g., those of Table 1 being applied during a procedure and those ofTable 2 being applied before or after the procedure). In otherembodiments, the fluid may be sprayed at completion of a procedure aftertissue is cut. Spray may be delivered during (continuously orintermittently) or after cutting and/or may be delivered before coveringtooth, bone or other tissue with for example a protectant. Biocompatibleamounts may be applied, for example, using ion concentrations similar tothose used for employing ions to protect wounds in the prior art. Inhard tissue when a cut is covered, although ions may stay entrapped,their effect normally will be harmless. (See, for example, amounts ofsilver ions used for burn wounds, which is incorporated herein byreference.)

The information provided herein may be applied to treatment of both hardand soft tissues. Recipes for obtaining colloidal suspensions of silverand other ions in aqueous solution are available in the prior art. Forexample, recipes for compounds that include antibacterial cations suchas silver, zinc, copper, etc. are described in U.S. Pat. No. 6,759,544,which recipes are included herein by reference. Additional exemplaryrecipes appear in the following, the recipe contents of which areincorporated herein by reference:

http://www.silver-colloids.com/Reports/cpr25/cpr_(—)25.html

http://www.silver-colloids.com/Reports/reports.html

http://www.jnj.com/news/jnj_news/20030325_(—)105204.htm

http://www.jnj.com/news/jnj_news/20040413_(—)120700.htm

http://www.burnsurgery.org/Modules/nano/p2/sec2.htm

U.S. Pat. No. 6,827,766, the entire contents of which are expresslyincorporated herein by reference, includes a description on formulationof nanoparticle biocides in forms of sprays, fogs, aerosols, and thelike.

U.S. Pat. No. 6,051,254, the entire contents of which are expresslyincorporated herein by reference, discloses a pharmaceutical formulationcomprising an amoxycillin hydrate that may, when made up in an aqueoussolution, be applied according to an implementation of a method of thepresent invention.

Another aspect of the present invention may comprise a method ofdelivering ions (e.g., disinfectant and/or other ions) to a targetsurface, details of which are disclosed U.S. application Ser. No.11/033,032, filed Jan. 10, 2005 and entitled ELECTROMAGNETIC ENERGYDISTRIBUTIONS FOR ELECTROMAGNETICALLY INDUCED DISRUPTIVE CUTTING.Particles, which may comprise selected types of ions (e.g., silver,copper, zinc, fluoride or other ions), may be projected onto the targetsurface. According to an exemplary embodiment, an air spray, fluid sprayor a combination spray of both air and fluid (e.g., water) may be usedto project particles (e.g., disinfectant ions, other ions, and/or ioniccompounds) onto the target surface before, during (continuously orintermittently) or after a procedure in order to allow the particles toattach or adhere (e.g., to micromechanically bond) to the surface. Forinstance, particles (e.g., disinfectant ions) may be fed into a gas line(e.g., an air line of a handpiece) and delivered to a target surfaceunder pressure of air (with or without simultaneous application ofliquid) to thereby project particles onto and/or into the targetsurface. According to one implementation, the surface may or may not beremodeled as described, for example, in the above-incorporatedapplication, wherein the remodeled tissue layer may be more resistant tocaries formation. The process further may stimulate formation ofsecondary dentin and/or may cause the surface to exhibit antibacterialproperties. According to another aspect of the present invention, alamination layer may be applied over a target tissue surface so that thetissue surface is laminated with various ionic compounds and thenremodeled with a laser. In a modified implementation, the tissue may belaminated and remodeled at the same time. Either a wet or dryenvironment may be employed to implement ions into the tissue.

As examples, ions from a list including silver, copper, zinc, fluoride,calcium, phosphorous, hydroxide, combinations thereof, and ioniccompounds including one or more of the preceding, may be selected thatmay, for example, enhance caries prevention. As another example,compounds containing ions, such as sodium fluoride, stannous fluoride,copper fluoride, titanium tetrafluoride, amine fluorides, calciumhydroxide, silver compounds, copper compounds, zinc compounds,combinations thereof, and the like, may be selected. It should be notedthat some of these compounds may be compatible with soft tissue, andsome may be compatible with dentin, enamel, or bone only. Moreparticularly, compounds having, for example, a fluoride ion may beeffective as anti-caries and desensitizing agents. In accordance withone example, fluoride may act to desensitize dental tissue to effectsof, for example, heat and cold. In modified embodiments, compoundsincluding, for example, calcium may aid in forming an anti-bacterialsurface. In still further embodiments, remineralization of affecteddentin may be enhanced by employing, for example, calcium hydroxide orzinc oxide. These compounds may be delivered, for example, through wateror other biocompatible fluids that may, for example, contain salt, aresterile, and/or are low in bacterial count.

The ionic compounds may be applied simultaneously (continuously orintermittently) with application of a laser beam, thereby achievingplacement of ions and, at the same time, optionally remodeling surfacetissue and impregnating ions into a remodeled layer of tissue.Alternately, an area to be treated first may be sprayed continuously orintermittently with one or more ion-containing compounds, such as atopical fluoride preparation, followed by subsequent application oflaser energy.

With reference to FIGS. 22-25, additional disclosure is provided in theform of a fluid conditioning system configured as a fluid supply and/orfluid control arrangement or assembly. The assembly may be adapted inwhole or in part to existing medical and dental apparatuses, includingthose used for cutting, irrigating, evacuating, cleaning, drilling,and/or therapeutic procedures. According to one feature, the fluidconditioning system may be embodied, for example, as a fluid controllerto employ conditioned (e.g., sterile) fluid in place of or in additionto regular tap water or other types of liquid (e.g., distilled water,deionized water, or water with a controlled number of colony formingunits (CFU) per milliliter, and the like), during various clinicaloperations.

A fluid controller for use in an exemplary context of anelectromagnetic-energy assisted operation or procedure (e.g., surgery)can be embodied with a fluid controller (e.g., comprising a flow-controlcassette) for directing fluid (e.g., conditioned fluid) toward a target(e.g., tissue) whereby electromagnetic (e.g., laser) energy can befocused in the same direction to disrupt (e.g., ablate or cut) or treatthe target, with the fluid controller operating to direct theconditioned fluid in the same direction to effectuate the disrupting ortreating. The fluid may be supplied as and/or conditioned fluidcomprising or being, for example, a sterile fluid. In certainembodiments, the fluid may be supplied and/or conditioned to comprise orbe, for example, a liquid such as water, while in other embodiments itmay comprise or be, for example, sterile water. For instance,fluid-controller assemblages may be constructed to controllably providefluid such as conditioned fluid (e.g., sterile water).

FIG. 22 a depicts a fluid controller in the form of a sterile watercontroller adapted for use with an existing Waterlase MD system 31 (FIG.22 b; cf. http://www.biolase.com/waterlasemd/) or Waterlase MBA system(not shown; cf. http://www.dotmed.com/listing/816579) according to anembodiment of the present invention, and FIG. 22 b diagrams a fluidcontroller exemplified as a sterile water kit suitable for use inparticular with an existing Waterlase MD system 31 according to anembodiment of the present invention. A fluid controller 30 (alsoreferenced herein as a water control or a cassette controller),supported for instance by a pole on wheels, is operatively coupled via awater connector 32 to a water bottle 33, which may comprise, forexample, a source of clean water 33 a or a sterile solution bag 33 b.

The fluid controller 30 is further and/or alternatively operativelycoupled to (and/or comprises, or is) a flow-control cassette 35, whichtypically is positioned downstream of the water bottle 33 and/oroperatively coupled via a handpiece connector 37 to a handpiece 39(e.g., a sterile handpiece). A water line 40 can be connected to supplyfluid (e.g., water) from the flow-control cassette 35 to the handpiececonnector 37. Additionally and/or alternatively, an air connector 42(also referenced herein as an air intake) can couple a source of air(not shown) to an air-flow controller 44, which may comprise, forexample, a fixed air regulator 44 a (e.g., 30 PSI) and/or an air flowcontrol module 44 b (e.g., proportional valve). The air-flow controller44 may be coupled to an air filter 45, which can be coupled to an airline 46 which in turn can be coupled to the handpiece connector 37.Fiber cable attachments 47 can be used to hold the water line 40 and theair line 46. The assemblage of elements between the water connector 32,air connector 42, and handpiece connector 37 of either of FIGS. 22 a and22 b may be referred to and used as a disposable sterile set assembly ordisposable tubing assembly 48.

A fluid controller according to a typical incarnation can comprise awater-spray upgrade kit, adaptable for use with an apparatus comprisingan electromagnetic energy source and a fluid output such as describedabove or a Waterlase MD laser system 31. The electromagnetic energysource can house, for example, an air control/water control (ACWC)control board 31 a, an ACWC manifold 31 b, and cassette controller lines31 c, the latter of which may in one implementation comprise part of adisposable tubing assembly 48. The fluid controller may be configurableto operate as a sterile water (e.g., a saline solution, or a balancedsaline solution) delivery system for the apparatus or Waterlase M Dlaser system for uses including but not limited to, dental, ophthalmicand surgical procedures.

FIG. 23 is a block diagram of a fluid controller in the form of asterile water controller 30 according to an exemplary arrangement of thepresent invention. Here, an air filter 45 is coupled between an air line46 and an air-flow controller 44. The air-flow controller 44 can couplea source of air 50 to, for example, a fixed air regulator 44 a (e.g., 30PSI) and/or an air flow control module 44 b (e.g., proportional valve).Furthermore, an air pressure ON/OFF (3-way valve) 53 can be coupledbetween the ACWC control board 31 a, the water bottle 33, and theair-flow controller 44.

With regard to sterile-water kit embodiments, such as depicted in FIG.22 b for use/installation with/on existing Waterlase MD systems, suchcan be implemented with, for instance, an MD handpiece that is slightlymodified or redesigned to allow for external connection of the air andwater lines. The kit can be provided with, for example, a cassettehousing (water flow control) with mechanical features to attachexternally to a current MD system. The kit can comprise, for instance,five subsystems, each having a separate specification, as follows:sterile spray air control/water control (ACWC), water bottle, disposablesterile assembly, sterile handpiece, and sterile solution bag. Thesterile spray ACWC can comprise an ACWC as provided on the currentWaterlase MD with additional components of an air selector valve,cassette control valves (3), control PCB, and cassette housing. Thewater bottle/sterile solution bag holder can comprise a bottle similarto that currently on production with the Waterlase MD system, but with,e.g., a piercing straw feature for the sterile solution bag.Furthermore, the disposable sterile assembly can comprise a water flowcontrol cassette, sterile air fitter, and sterile tubing set for air andwater with fittings, whereby the air and water flow can be comparable toexisting Waterlase MD flow levels. According to a particular embodiment,flow control (e.g., all flow control) can be set using existing graphicuser interface (GUI) controls.

In the embodiment illustrated in FIG. 23, an air regulator 55, a waterregulator 56, a DC input 57, a START/STOP input 59, i.e., for receivingstart and stop signals from a footswitch, and an ON/OFF button 63operate together as part of an air control/water control (ACWC)controller board 60 (cf. 31 a, FIG. 22 b). The schematic diagram in FIG.24 depicts a sterile water flow-control cassette 35 according to animplementation of the present invention, in which a water connector 32and a water line 40 operate to input water into and output water from,respectively, the flow-control cassette 35.

Upon entering the flow-control cassette 35, water is influenced and/orenabled to move toward the water line 40 via a selected two or more of aplurality of flow-control passages. As presently embodied, at least twoof the flow-control passages have different resistances to flow. Forexample, the two or more flow-control passages may be provided withdifferent lumen constructions thereby providing them with differentresistances to flow. In one implementation, the two or more flow-controlpassages are provided with different cross-sectional areas. A particularexample can comprise each being provided with a flow restrictor 66 and apinch (e.g., electronically controlled on/off) membrane 68. As presentlyembodied, provision of each passage with a different resistance to flowconveniently and reliably provides for a relatively large number ofdifferent flow-resistances through the flow-control cassette 35. Forinstance, while the number of flow-control passages can range from fourto eight, or alternatively two to three, or even nine to twenty, forinstance, the illustrated arrangement utilizes three selectableflow-control passages A, B and C, to provide respective resistances toflow of “1,” “2” and “4,” and further to provide additional selectableresistances to flow of “3” (AB), “5” (AC), “6” (BC), and “7” (ABC)through the flow-control cassette 35.

The architecture of FIG. 25 provides a schematic diagram of a sterilewater flow-control cassette 35 according to another implementation ofthe present invention. Here, provision of each flow-control passage witha different resistance to flow conveniently and reliably provides for arelatively large number of different flow-resistances through theflow-control cassette 35. As with the implementation of FIG. 24, eachflow-control passage can be (a) preset and/or preconfigured to have apredetermined flow rate and (b) during use can be either selected to beall the way “on” (e.g., enabled) or deselected to be all the way “off”(e.g., disabled). In a preferred embodiment, partial selection orpartial deselection of any one or more of the flow-control pathways isnot possible or is not enabled thereby providing for a low-cost, simpleconstruction, precision, and/or reliable operation.

With more particular reference to FIG. 25, the illustrated arrangementcomprises three flow-control passages CH1, CH2 and CH3, each with arespective different flow resistance. For instance, the flow-controlpassages CH1, CH2 and CH3 can be provided with different cross-sectionalshapes, materials, interior surfaces or structures, path lengths, and/orareas. In the illustrated example, the flow-control passages CH1, CH2and CH3 can be provided with different cross-sectional areas such asdefined by the diameters of CH1 (0.003″), CH2 (0.004″) and CH3 (0.005″).Under an input pressure of 35 PSI, for instance, the flow-controlpassages CH1, CH2 and CH3 may provide different flow rates such as CH1(3 ml/min), CH2 (6 ml/min) and CH3 (10 ml/min) thereby to provide aflow-control cassette 35 controllable to provide flow rates of 3, 6, 9,10, 13, 16 and 19

According to certain implementations, laser energy from the trunk fiberis output from a power or treatment fiber, and is directed, for example,into fluid (e.g., an air and/or water spray or an atomized distributionof fluid particles from a water connection and/or a spray connectionnear an output end of a handpiece) that is emitted from a fluid outputof a handpiece above a target surface (e.g., one or more of tooth, hone,cartilage and soft tissue). The fluid output may comprise a plurality offluid outputs, concentrically arranged around a power fiber, asdescribed in, for example, App. 11/042,824 and Prov. App. 60/601,415.The power or treatment fiber may be coupled to an electromagnetic energysource comprising one or more of a wavelength within a range from about2.69 to about 2.80 microns and a wavelength of about 2.94 microns. Incertain implementations the power fiber may be coupled to one or more ofan Er:YAG laser, an Er:YSGG laser, an Er, Cr:YSGG laser and a CTE:YAGlaser, and in particular instances may be coupled to one of an Er,Cr:YSGG solid state laser having a wavelength of about 2.789 microns andan Er:YAG solid state laser having a wavelength of about 2.940 microns.An apparatus including corresponding structure for directingelectromagnetic energy into an atomized distribution of fluid particlesabove a target surface is disclosed, for example, in thebelow-referenced U.S. Pat. No. 5,574,247, which describes theimpartation of laser energy into fluid particles to thereby applydisruptive forces to the target surface.

By way of the disclosure herein, a laser assembly has been describedthat can output electromagnetic radiation useful to diagnose, monitorand/or affect a target surface. In the case of procedures using fiberoptic tip radiation, a probe can include one or more power or treatmentfibers for transmitting treatment radiation to a target surface fortreating (e.g., ablating) a dental structure, such as within a canal. Inany of the embodiments described herein, the light for and/ordiagnostics may be transmitted simultaneously with, or intermittentlywith or separate from, transmission of treatment radiation and/or of thefluid from the fluid output or outputs.

Corresponding or related structure and methods described in thefollowing patents assigned to Biolase Technology, Inc, are incorporatedherein by reference in their entireties, wherein such incorporationincludes corresponding or related structure (and modifications thereof)in the following patents which may be, in whole or in part, (i) operablewith, (ii) modified by one skilled in the art to be operable with,and/or (iii) implemented/used with or in combination with, any part(s)of the present invention according to this disclosure, that of thepatents or below applications, and the knowledge and judgment of oneskilled in the art.

Such patents include, but are not limited to U.S. Pat. No. 7,578,622entitled Contra-angle rotating handpiece having tactile-feedback tipferrule; U.S. Pat. No. 7,575,381 entitled Fiber tip detector apparatusand related methods; U.S. Pat. No. 7,563,226 entitled Handpieces havingillumination and laser outputs; U.S. Pat. No. 7,467,946 entitledElectromagnetic radiation emitting toothbrush and dentifrice system;U.S. Pat. No. 7,461,982 entitled Contra-angle rotating handpiece havingtactile-feedback tip ferrule; U.S. Pat. No. 7,461,658 entitled Methodsfor treating eye conditions; U.S. Pat. No. 7,458,380 entitled Methodsfor treating eye conditions; U.S. Pat. No. 7,424,199 entitled Fiber tipfluid output device; U.S. Pat. No. 7,421,186 entitled Modified-outputfiber optic tips; U.S. Pat. No. 7,415,050 entitled Electromagneticenergy distributions for electromagnetically induced mechanical cutting;U.S. Pat. No. 7,384,419 entitled Tapered fused waveguide for deliveringtreatment electromagnetic radiation toward a target surface; U.S. Pat.No. 7,356,208 entitled Fiber detector apparatus and related methods;U.S. Pat. No. 7,320,594 entitled Fluid and laser system; U.S. Pat. No.7,303,397 entitled Caries detection using timing differentials betweenexcitation and return pulses; U.S. Pat. No. 7,292,759 entitledContra-angle rotating handpiece having tactile-feedback tip ferrule;U.S. Pat. No. 7,290,940 entitled Fiber tip detector apparatus andrelated methods; U.S. Pat. No. 7,288,086 entitled High-efficiency,side-pumped diode laser system; U.S. Pat. No. 7,270,657 entitledRadiation emitting apparatus with spatially controllable output energydistributions; U.S. Pat. No. 7,261,558 entitled Electromagneticradiation emitting toothbrush and dentifrice system; U.S. Pat. No.7,194,180 entitled Fiber detector apparatus and related methods; U.S.Pat. No. 7,187,822 entitled Fiber tip fluid output device; U.S. Pat. No.7,144,249 entitled Device for dental care and whitening; U.S. Pat. No.7,108,693 entitled Electromagnetic energy distributions forelectromagnetically induced mechanical cutting; U.S. Pat. No. 7,068,912entitled Fiber detector apparatus and related methods; U.S. Pat. No.6,942,658 entitled Radiation emitting apparatus with spatiallycontrollable output energy distributions; U.S. Pat. No. 6,829,427entitled Fiber detector apparatus and related methods; U.S. Pat. No.6,821,272 entitled Electromagnetic energy distributions forelectromagnetically induced cutting; U.S. Pat. No. 6,744,790 entitledDevice for reduction of thermal lensing; U.S. Pat. No. 6,669,685entitled Tissue remover and method; U.S. Pat. No. 6,616,451 entitledElectromagnetic radiation emitting toothbrush and dentifrice system;U.S. Pat. No. 6,616,447 entitled Device for dental care and whitening;U.S. Pat. No. 6,610,053 entitled Methods of using atomized particles forelectromagnetically induced cutting; U.S. Pat. No. 6,567,582 entitledFiber tip fluid output device; U.S. Pat. No. 6,561,803 entitled Fluidconditioning system; U.S. Pat. No. 6,544,256 entitled.Electromagnetically induced cutting with atomized fluid particles fordermatological applications; U.S. Pat. No. 6,533,775 entitledLight-activated hair treatment and removal device; U.S. Pat. No.6,389,193 entitled Rotating handpiece; U.S. Pat. No. 6,350,123 entitledFluid conditioning system; U.S. Pat. No. 6,288,499 entitledElectromagnetic energy distributions for electromagnetically inducedmechanical cutting; U.S. Pat. No. 6,254,597 entitled Tissue remover andmethod; U.S. Pat. No. 6,231,567 entitled Material remover and method;U.S. Pat. No. 6,086,367 entitled Dental and medical procedures employinglaser radiation; U.S. Pat. No. 5,968,037 entitled User programmablecombination of atomized particles for electromagnetically inducedcutting; U.S. Pat. No. 5,785,521 entitled Fluid conditioning system; andU.S. Pat. No. 5,741,247 entitled Atomized fluid particles forelectromagnetically induced cutting.

Also, the above disclosure and referenced items, and that described onthe referenced pages, are intended to be operable or modifiable to beoperable, in whole or in part, with corresponding or related structureand methods, in whole or in part, described in the following publishedapplications and items referenced therein, which applications are listedas follows: App. Pub, 20090225060 entitled Wrist-mounted laser withanimated, page-based graphical user-interface; App. Pub. 20090143775entitled Medical laser having controlled-temperature and sterilizedfluid output; App. Pub. 20090141752 entitled Dual pulse-width medicallaser with presets; App. Pub. 20090105707 entitled Drill and flavoredfluid particles combination; App. Pub. 20090104580 entitled Fluid andpulsed energy output system; App. Pub. 20090076490 entitled Fiber tipfluid output device; App. Pub. 20090075229 entitled Probes and biofluidsfor treating and removing deposits from tissue surfaces; App. Pub.20090067189 entitled Contra-angle rotating handpiece havingtactile-feedback tip ferrule; App. Pub. 20090062779 entitled Methods fortreating eye conditions with low-level light therapy; App. Pub.20090056044 entitled Electromagnetic radiation emitting toothbrush anddentifrice system; App. Pub, 20090043364 entitled Electromagnetic energydistributions for Electromagnetically induced mechanical cutting; App.Pub. 20090042171 entitled Fluid controllable laser endodontic cleaningand disinfecting system; App. Pub. 20090035717 entitled Electromagneticradiation emitting toothbrush and transparent dentifrice system; App.Pub. 20090031515 entitled Transparent dentifrice for use withelectromagnetic radiation emitting toothbrush system; App. Pith.20080317429 entitled Modified-output fiber optic tips; App. Pub.20080276192 entitled Method and apparatus for controlling anelectromagnetic energy output system; App. Pub. 20080240172 entitledRadiation emitting apparatus with spatially controllable output energydistributions; App. Pub. 20080221558 entitled Multiple fiber-type tissuetreatment device and related method; App. Pub. 20080219629 entitledModified-output fiber optic tips; App. Pub. 20080212624 entitled Dualpulse-width medical laser; App. Pub. 20080203280 entitled Target-closeelectromagnetic energy emitting device; App. Pub, 20080181278 entitledElectromagnetic energy output system; App. Pub. 20080181261 entitledElectromagnetic energy output system; App. Pub. 20080157690 entitledElectromagnetic energy distributions for electromagnetically inducedmechanical cutting; App. Pub. 20080151953 entitled Electromagnet energydistributions for electromagnetically induced mechanical cutting; App.Pub. 20080138764 entitled Fluid and laser system; App. Pub. 20080125677entitled Methods for treating hyperopia and presbyopia via, lasertunneling; App. Pub. 20080125676 entitled Methods for treating hyperopiaand presbyopia via laser tunneling; App. Pub. 20080097418 entitledMethods for treating eye conditions; App. Pub. 20080097417 entitledMethods for treating eye conditions; App. Pub. 20080097416 entitledMethods for treating eye conditions; App. Pub. 20080070185 entitledCaries detection using timing differentials between excitation andreturn pulses; App. Pub. 20080069172 entitled. 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All of the contents of the preceding applications, materials, andreferenced matters/content are incorporated herein by reference in theirentireties. Although the disclosure herein refers to certain illustratedembodiments, it is to be understood that these embodiments have beenpresented by way of example rather than limitation. For example, any ofthe radiation/energy outputs (e.g., lasers), any of the fluid outputs(e.g., water outputs), and any conditioning agents, particles, agents,etc., and particulars or features thereof, or other features, includingmethod steps and techniques, may be used with any other structure(s) andprocess described or referenced herein, in whole or in part, in anycombination or permutation as a non-equivalent, separate,non-interchangeable aspect of this invention. Corresponding or relatedstructure and methods specifically contemplated, disclosed, referencedand/or claimed herein as part of this invention, to the extent notmutually inconsistent as will be apparent from the context, thisspecification, and the knowledge of one skilled in the art, including,modifications thereto, which may be, in whole or in part, (i) operableand/or constructed with, (ii) modified by one skilled in the art to beoperable and/or constructed with, and/or (iii) implemented/made/usedwith or in combination with, any parts of the present inventionaccording to this disclosure, include: (I) any one or more parts of theabove disclosed or referenced structure and methods and/or (II) subjectmatter of any one or more of the following claims and parts thereof, inany permutation and/or combination. The intent accompanying thisdisclosure is to have such embodiments construed in conjunction with theknowledge of one skilled in the art to cover all modifications,variations, combinations, permutations, omissions, substitutions,alternatives, and equivalents of the embodiments, to the extent notmutually exclusive, as may fall within the spirit and scope of theinvention as limited only by the appended claims.

1. An apparatus using conditioned fluid to treat a tissue target,comprising: a fluid output pointed in a general direction of aninteraction region, the fluid output being constructed to placeconditioned fluid particles into the interaction region, the interactionregion being defined at a location above the target and the conditionedfluid being compatible with the target; a flow-control cassette coupledto the fluid output and comprising a plurality of selectable passagescoupled to pass the conditioned fluid with different flow rates; and anelectromagnetic energy source pointed in a direction of the interactionregion, the electromagnetic energy source being constructed to deliverinto the interaction region a peak concentration of electromagneticenergy that is greater than a concentration of electromagnetic energydelivered onto the target, the electromagnetic energy having awavelength which is substantially absorbed by the conditioned fluid inthe interaction region, wherein the absorption of the electromagneticenergy by the conditioned fluid energizes the fluid causing the fluid toexpand and wherein disruptive forces are imparted onto the target. 2.The apparatus of claim 1, wherein: the fluid output is constructed tocontinuously place conditioned fluid into the interaction region for solong as instructed by a user input while a fluid conditioning cartridgeis coupled to the apparatus; and the fluid output is constructed tocontinuously place non-conditioned fluid into the interaction region forso long as instructed by a user input while the fluid conditioningcartridge is coupled to the apparatus.
 3. The apparatus of claim 1,wherein: the fluid output is constructed to continuously placeconditioned fluid into the interaction region for so long as instructedby a user input while a fluid conditioning cartridge is coupled to theapparatus; and the fluid output is constructed to continuously placereduced-concentration conditioned fluid into the interaction region forso long as instructed by a user input while the fluid conditioningcartridge is coupled to the apparatus.
 4. The apparatus of claim 1,wherein the fluid output is constructed to continuously placeconditioned fluid into the interaction region for so long as a fluidconditioning cartridge is coupled to the apparatus.
 5. The apparatus asset forth in claim 4, wherein the fluid conditioning cartridge injects aconditioning agent into a fluid, whereby a conditioned fluid is formed.6. The apparatus as sa forth in claim 5, wherein: the conditioning agentis a disinfectant; and the conditioned fluid comprises a composition(e.g., concentration) of the disinfectant that is suitable for use onthe target in combination with the electromagnetic energy for generationof the disruptive forces.
 7. The apparatus as set forth in claim 6,wherein the target comprises hard or soft tissue.
 8. The apparatus asset forth in claim 5, wherein: the fluid conditioning cartridge is afirst fluid conditioning cartridge that injects conditioning agent intothe fluid to form conditioned fluid having a first composition (e.g.,concentration); and the fluid output is constructed to continuouslyoutput conditioned fluid having a second composition (e.g.,concentration) when a second fluid conditioning cartridge is coupled tothe apparatus.
 9. The apparatus as set forth in claim 8, wherein thesecond fluid conditioning cartridge injects conditioning agent into thefluid to form conditioned fluid having the second composition (e.g.,concentration) of conditioning agent.
 10. The apparatus as set forth inclaim 9, wherein the conditioning agent is a disinfectant, the firstcomposition is a first concentration of disinfectant, and the secondcomposition is a second concentration of disinfectant that is differentthan the first concentration of disinfectant.
 11. The apparatus as setforth in claim 9, wherein the second composition (e.g., concentration)has a discernable physical property that is greater than the samediscernable physical property of the first composition (e.g.,concentration).
 12. The apparatus as set forth in claim 11, wherein thediscernable physical property is concentration of conditioning agent.13. The apparatus as set forth in claim 11, wherein: the conditioningagent is a disinfectant; and the conditioned fluid comprises acomposition (e.g., concentration) of the disinfectant that is suitablefor use on the target in combination with the electromagnetic energy forgeneration of the disruptive forces.
 14. The apparatus as set forth inclaim 8, wherein the second fluid conditioning cartridge is constructedto be coupled to the apparatus in place of the first fluid conditioningcartridge.
 15. The apparatus as set forth in claim 9, wherein: the fluidconditioning cartridge is a first fluid conditioning cartridge; thefluid output is constructed to continuously output conditioned fluidhaving a first composition (e.g., concentration) of disinfectant that issuitable for use on the target, when the first fluid conditioningcartridge is coupled to the apparatus; and the fluid output isconstructed to continuously output conditioned fluid having a secondcomposition (e.g., concentration) of disinfectant that is suitable fordisinfecting a supply line, when a second fluid conditioning cartridgeis coupled to the apparatus.
 16. The apparatus as set forth in claim 15,wherein the second fluid conditioning cartridge is constructed to becoupled to the apparatus in place of the first fluid conditioningcartridge.
 17. The apparatus as set forth in claim 16, wherein thesecond composition (e.g., concentration) has a discernable physicalproperty that is greater than the same discernable physical property ofthe first composition (e.g., concentration).
 18. The apparatus as setforth in claim 17, wherein the discernable physical property isconcentration of conditioning agent.
 19. The apparatus as set forth inclaim 1, and further comprising a fluid conditioning cartridge, thefluid conditioning cartridge being configured to inject a conditioningagent, whereby a conditioned fluid is formed.
 20. The apparatus as setforth in claim 1, wherein: the conditioned fluid comprise adisinfectant; and a composition (e.g., concentration) of thedisinfectant within the conditioned fluid particles is suitable for useon the target in combination with the electromagnetic energy forgeneration of the disruptive forces.